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TQ BE FILED WITH
<br /> Appiication for Exemption o�M
<br /> YOUR COUN7Y from MotorVehicleTaxes
<br /> 7REASURER by Qualifying Nonprofit Organizations 457
<br /> •Read instructions on reverse side
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<br /> Applicant's Name Gounty Type of Ownership
<br /> �0�� �RPiOR. Z�C I3AT L _____ �Nonprofit
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<br /> Street or Other Mailing Address Gounty Number Corporation
<br /> 6LO w ll1VTS10�3 ST PO BOX 1s44 - ---. 4Q_ _ ❑other�sPe��tY,:
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<br /> City State Zip Code State Where Incorporated
<br /> GRAh�ll IST.AND NE 6$802 NF. -_
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<br /> Ideritity O(ticers,Dirc�ctors,or Partners
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<br /> Title Name,Address,City,State,zip Code
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<br /> _�tf r t.t���!���_��- _ ' �S`�r� I�-c��.c�k��_�L�o �ti �a��r� �-,� , ���.._. �[>����:,�
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<br /> C DESCRIPTION OF THE M070R VEHICL�S �
<br /> tach additipnal sheet if necessary
<br /> --.,_._. __._..,..�PEGAi..--.-. .,..__..
<br /> Reyistration Date or�ale
<br /> Vehir..ln Mak? I Mpdel Vear � Rod,i T;�pe VehiclA I�ynti(ic:3�ivr�Ni.imher of Acquisition if Nhwly
<br /> �'urchased
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<br /> , .�C�N t?W�'�i_...�t�7-Cc'�... `�S____ ,.. ,,_� �a 1 I
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<br /> Nature of Use of Motor V?hicle: Are the molor vehicles used
<br /> �Agrir,ultural/Horticuliural ��ducational �Religious �Charitable �Cemetery exclusively as indlcated?
<br /> Give detailed description of use,including an explanation if multiple classitications exist: �YES �NO
<br /> �-!}•�[✓ I������U�� �'���-J���.'e��, /c-, [rl�����f/ j Ix_��.� � Ii No,give percentage:_l��' %
<br /> L.��� �' C��'G�► � � � � r�L�CG' � ►� �YL�'1�c.���`'�'1S - ���������
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<br /> _.. Under penalties of law m_ — ,,.__.--- — - --------------.,..., ...... �
<br /> � ,I declare that I have examined this application and,to the best af my knowled e and belief,it is correct and
<br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organixation wnmg said proper:tyidpes�not�y
<br /> discriminate in membership or employment based on race,color,or national origin. TF"G_-,5'..?F:�.R�r'FF�CC
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<br /> here Aulh ize ignaturo , Title date �
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<br /> � 9} TYT-'��.'�SJnCFi'S nECOffiv"iEivvilifvi� �
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<br /> �PROVAL CdMMENTS: ���,._.o.si<S.� � � G _..._..
<br /> [�DISAPPROVAL ---. __.
<br /> Signaiu ��c� t r��?'�J `r"_,:�G} --'e�C.�
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<br /> re of County TreasGrer f]ate
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<br /> � FOR COUNTY BOARD OF EaUALIZATION USE ONLY
<br /> �APPH�VAL COMMENTS: ..__ -- -- --.._...------. .......,.—
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<br /> ❑ DISAPPROVAL --.�. ..... __.__ �__ �I�/ .. .. ._.... '�.,.�--.....�—�—_,.T
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<br /> Aut riaed Signature` / �ate
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<br /> Authorized 6y Ne6.liev.5tat.§T%-202 1 C cl, CO-3,
<br /> Nebras'ka pepartmenl o(Revanuo ��5§6�-'����9
<br /> �36•253-2006 Rev,5-2009 Supersedes 96-253-2006 Rev.71-2008
<br /> PLEASE MAKE A CQPY FOR YOUR RECORDS
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