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<br /> TQ BE FILEI]WITH Application for Exemption FORM
<br /> YOUR cOUNTY from MotorVehicleTaxes
<br /> TREASURER by Qualifying Nonprofit Organizations 457
<br /> •Read instructions on reverse side
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<br /> Applicant's Name County Type oi Ownership
<br /> IGLF.SIA llE DIOS EBIyN—EZ—ER _HALL _ �rvonprotit
<br /> _ _._._.
<br /> Street or Qther Mailing Address Gounty Number Corporation
<br /> 2525 W STATE ST PO BOX 486 40 --- ..._.... .. ❑other(specity):
<br /> _.,___. _..... _...... .._._._ . ..,...
<br /> ���y State Zip Code State Where Incorporated
<br /> GRAND ZSLAI�T�) NE b8$02 I�IF _
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<br /> Identify Officers Drtectors,nr Partners
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<br /> Tdle Name Address Cdy,State,Zip Code
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<br /> �.r 1-Fc .�-�-�e� _...._. ��G.rI�, �� ;11v //! Lc./e�•...._ /.�•�r 5•, �1-r�.r__ �/s ��P��/ ,. _..
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<br /> LIST SPECIFIC D�SCRIPTION OFTH�MpTpR VEHICI�ES
<br /> C •Attach additional sheet if necessary
<br /> ._.__ ._ _ ._ ___ _ __ _ _ .
<br /> Reyislration Uate,or Date
<br /> Vehicle Make ModelYear BodyType Vehicl�Id�ntification Number of Acquisition if Newly
<br /> � Purchased
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<br /> �;�>��° _...� i�i i� 5' c� ':'u r 2.�5-1� �s���L/Ks� ' __. _._
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<br /> Natur�of Use of Motor Vehicle: Are the motor vehicles used
<br /> �Agricultural/Horticultural �Educational �Religious �Charitabte �Cemetery exclusively as indicated?
<br /> Give detailec�description of use,including an explanation if multiple classi(ications exist: �x�YES �Np
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<br /> �� `J�,���� � ��� v l�� � 1 iv �1.������ � o,give �����
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<br /> Under penalties of law,1 declare that I have examined this application and,to the best of my knowledge an beheT,it is correc!a.�rdr� {r rY
<br /> complete.I also declare that I am duly a orized to sign this exemption applicatipn,and that the organization owni g said prop�riy�pes�fia3 F'C�
<br /> discriminate.in.�nembership or emplo.y' ent based on race,color,or national origin. ��'-�, -�� - -' '�A r
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<br /> SIg�1 :�- ' - /2 �a%i/�'r�
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<br /> here Aut�nze[i Signatu�e — Tiile � Date
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<br /> � _.. --- __ _...._.,.�
<br /> FOR COUNTYTREASURER'S RECOMMENDATIQN
<br /> �-- -.._ _..._ - --- , --
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<br /> �-�,PPROVAL GOMMENTS: -l� '_�.:�� � ����0��
<br /> �IJISAPPI�OVAL — __ -- _ _
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<br /> Signature of County Treasurer Date
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<br /> �J FOR COUNTY BOARD QF EQUALIZA710N USE ONLY
<br /> ❑AI'PRQVAL COMMEN75: --
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<br /> ❑DISAPPHOVAL ... n j /1 _....1�,! ` _.
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<br /> Aut rized Si nature � Date
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<br /> �-����• �"" -�--���'^ Authorized 6y Neb.Rev,S�BL§77-2q2(1)(c)(d),§60-3,185§G03,1A9
<br /> Nrbraska IJepartment of Rovenue
<br /> 96-253•2006 Rev,S-2009 Suparsedes 9G-253-2D06 Rev.11-2008
<br /> PLEASE MAKE A CQPY FOR YOUR RECOF�DS
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