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, zo11 <br /> R= ,�Q BE F,�EOW,TH . Application for Exemption FORM <br /> YOUR COUNTY from MotorVehicleTaxes <br /> b Qualif in Non rofit(7r anizations ��� <br /> TREASURER Y Y g P 9 <br /> ___........... ..... •Read instructions on reverse side <br /> ApplicanCs Name County Type of Ownership <br /> GOODtid�LL TNDUSTRIES OF GREATER NEBRAST�A INC LL X�Nonprotit <br /> ------- _.._ _ ...—. _._........... <br /> _ __ _ _. ..._ <br /> Street or Other Mailing Address County Number Corporation <br /> 18��+ S EDDY $ST PO BOX lgfi� O �Other(specify): <br /> _ ._. _ .. -- <br /> CitY State Zip Code State Where Incorporated <br /> GRAND ISI.AND NE 68802 NE - - <br /> -- <br /> -- <br /> Identify Officers,Directors or Partners - <br /> — -- _ _ � <br /> _ _ _ _ <br /> Title Name,Address,Cit,State,Zi Code <br /> _ Y P <br /> _.... . <br /> �� __..-��13G1=1E __ ' <br /> - <br /> -- <br /> LIST SPECIFIC D�SCRIPTION Q�TME MOTOR VEMICLES <br /> •Attach additional sheet if necessary <br /> -- _ _... . -- -. - - .._ _ — <br /> Registration�ate or Date <br /> Vehicle Make Model Year Bpdy Type Vehicle Identification Number of Acquisition if Newly <br /> ___ _..._. .._ Purchased <br /> —�'"� _...--- - -—.... ., <br /> ���� , - - <br /> __.... _ -- -..... ._ _ ...-- -.... <br /> Nature ot Use of Motor Vehicle: Are the motor vehicles used <br />' ❑AgricWtural/Horticultural Educational r,Reli ious Charitable exclusively as indicated? <br /> LJ 9 � ❑Cemetery <br /> Give detailed description of use,including an explanation if multiple classifications exist: __._ �[ �YES n NO <br /> . • <br /> — . <br /> � _ _ • -���. <br /> . -- , � <br /> , (� �-y 1 -1 9�'._ <br /> . <br /> _�.�y.��T7"\"' L^ \��-1� C�\V_1-�"� S ��,�a�.. <br /> _ n�.� w�,�Y�� ��. <br /> _����$.��1�� ��.,_ ' ���-��-�-1-��. <br /> , . . <br /> . <br /> r�- r�,� o � ,, <br /> . <br /> � � 7 <br /> , . „�. <br /> , i � <br /> - (' - S. �il., <br /> _ _... � � Lvl <br /> --- - _ _. <br /> Under penalties of law,I declare that I have examined this applicaLon and,to the best ot my knowle ge and beliel it �corr�cl���,d�, <br /> complete I also declare that I em duly authorized to sign this exemption application,and that the organizatio owning said�o�ert��does n,o�t-F�r� <br /> discriminate in membership or employment based on race,color,pr national origin. C�?A'•�'3!:;:I�r.;_:.�'I.Fs�>,:,�;�.q <br /> Slgll _ <br /> _ _- - ---- -._.. _�� _. . �.�'_��..� <br /> here 'Authvri ignature Title ❑ate <br /> -- --- - _ . - <br /> FOR COUNTYTREASUREFi'S RECOMM�NpATION � <br /> �PPROVAL COMMENTS' _����f��G�'� _ _ <br /> �J DISAPPRC7VAL <br /> _ _.... .. <br /> _ <br /> ����...a - / <br /> � .���1'�-�'�tJ.. _ `'of�� !�' <br /> I ., --- --. <br /> Sig ure of County Treasur�r p�t� <br /> FOR CqUNTY BOARp pF EQUALIZA710N USE ONLY <br /> �]APPROVAL COMMENTS: __ <br /> � _ <br /> ❑PISAPPROVAL ' � - <br /> � I ' r <br /> ---- - _ .. , , <br /> _. ! __ _.. <br /> � <br /> Au 'o e,w ����- \� -•.-� _ ��. <br /> . . _ .. ....__._ .-- .... <br /> —. <br /> � d$i natuYe r / Date <br /> — <br /> 96-253-20UG Rev.5-2009 Super5edes96-253-2006 RBV.1 � <br /> Ne6raska bepartment of Revenuc Authonzod 6y NeG.Rev.Stat.§77-202(1)(cj(d),§GO-3,185§60-3,789 <br /> 7-2008 <br /> PLEASE MAKE A COPY FOR YpUR RECORDS <br />