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Appiication for Exemption zo��
<br /> Tp BE FII�ED WITH from Motor VehicleTaxes FORM
<br /> YOUR cOUN7Y by Qualifying Nonprofit Organizations (�,5�
<br /> 7REASURER •Read instructivns on reverse side
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<br /> ApplicanYs Name County Type ot Ownership
<br /> ]Njlp NEBKAST�A INDI�IIDUAI, SFRVICES INC HALL _ �]Nonprotit
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<br /> Street or Other Mailing Address County Number Corporation
<br /> 2536 1!T CARLETO�T AVE [4�..... ❑othe�(specity);
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<br /> City State Zip Code State Where Incnrporated
<br /> GRA�TD ISLADTD NE __6_8803 _.. .._ IdE_... -
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<br /> IdentiTy Officars �irectors,or Partners
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<br /> Title Name,AddrESS,City,State,zip Gode
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<br /> -����._. �Irn.e_�' f1'1u_r..r[�_st���• �re._1�.__r�tis��r ,�.� 6
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<br /> .. iC@ q�Cp�G�ta _ _ '— ����-.i_n �tn �=�[, ../.3`��lapn �c Cr���
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<br /> LIST SPECIFIC DESGRIPTION OF THE MOTOR VEHICLES
<br /> Attach additivnal sheet if necessary
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<br /> Hegistration Date or Date
<br /> Vehicle Ma.ke I Model Ye2r [3o�y Type� Vehicle Idcntifir.ation NurnY�er of Acquisition if Newly
<br /> Purchased
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<br /> Nature of Use of Motor Vehicle: Are lhe motor vehicles u5ed
<br /> �Agricultural/Hor[icultur2l ❑Fducational ��eligious Charitable �Cemetery
<br /> y dicated?
<br /> Give detailed description of use,including an explanation if multiple classifir,ations exist: �Y�S �NO
<br /> 16 5 -�- �t��v� 1'Y�.Q fl �1�t{ �d S0.�p��. C� If Na,�������E ��/
<br /> -f-r�� p o r � +� xc� �.'4:r:
<br /> r�,►�������s � ia� a���� �.����.s -� e��l�y,���� .
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<br /> com eteei�also delciare th t T y g _. __.....�.�.
<br /> - � ,I declare that I have examined this application and,to the best vf my knowled e and beliafr��ep�rFe.��at� �;:����
<br /> � I am dul authorized to si n this exemption applicatinn,and that the organization wning s�RQ���d{�gs.nRt-:�;��SKA
<br /> discriminate in membership or employment based on race,color,or national origin.
<br /> Slgfl �G � r ��-��'�[j
<br /> here �Aul ized �,at��
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<br /> Title Date
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<br /> � FOR COUNTY TREASURER'S R�COMMENDATION
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<br /> �APPROVAL COMMENTS. �s/ra�:r<f �i�', ! ��.;: � ''_:%"'_,� __ ,
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<br /> [f f71SAPPROVAL - -- - -
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<br /> � Signature of County 7reasurer IJate
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<br /> � FOR CQUNTY BOARD OF�QUALIZA710N USE ONLY
<br /> �]APPROVA� COMMEN7S: __.. _ —
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<br /> �DISAPPROVAL �.. .� , _.__. _,,. _,.
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<br /> � ��J 4�r � l 6... `- �T ....,, ,..,._'-
<br /> , Authorized Signature Date
<br /> Nebraska�eP ev.5-2009 Supersedes 96-253-?006 fie ---..,_ .........,- -.,,.._. ..,....�..,. ....- -----........-....._. _.,..... ��
<br /> � 2rtmenl of R2vanue Authnrized by NeG�Rev.Stat.§77•2�2(1)(c.)(d),§60-3,185§60-3.189
<br /> 96-258-2006 R v.11-200t1
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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