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<br /> 70 BE FILE�WITH Appiication for Exemption FoRM
<br /> from Motor Vehide Taxes
<br /> YOUR COUNTY by Qualifying Nonprofit Organizations 4,57
<br /> 7REASURER •Read instructivns on reverse side
<br /> _...,.. - -- -----....-_...—
<br /> ApplicanYs Name County Type of Ownership
<br /> NFBRASKA DISTRTCT COUNCIL OF T�iE ASSF.MBL�ES_O� GDD g3ALL . _.... .__ �X]rvonpra�ii
<br /> .. _.—.�
<br /> Street or Other Mailing Address County Number Corporation
<br /> 1503 W 2�D ST PO T30X 1�GS �0.... __....,_. ❑Other(speclfy):
<br /> City..._.._.. �. _, _._.. - - - _ _
<br /> State Zip Code State Where Incorporated
<br /> GRAND ISZ�AN� NE G8801 _� ......__...._,
<br /> —� . _ .... _ .
<br /> Icientify Officers Directors or Partners , _...—
<br /> Tille � Name,Address,Giry State,Zip Code
<br /> _.; ---
<br /> ,��;�, ,' ��� . . : ' ::� . .`'G��i��'L�`- �� ��_ _ -- --
<br /> " � ri �I1�11r"u���..���
<br /> .
<br /> � . . �
<br /> �:.���. , � . ���.`_Tl�_�d�r_..� - --------_..._
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<br /> ,�ffC'_��_, ___..��1.:d�ll.�_��G s� �Gt,� _12.:.._ /1 'C.� ��J�a��...,.
<br /> _._ _..._. _. _
<br /> _�.,,. __..._
<br /> _. _.... - _..__..
<br /> LIST SPECIFIC DESCRIPTION OF7ME MpTOR VEHICLES
<br /> �Attach additional sheet if necessar
<br /> Y
<br /> - ..._ - --, ,.__..__..,._...
<br /> _-.- .-- —- Ficgistralion ate or ate
<br /> Vehicle Make Model Year Body'fype Vehicle Idenli(ication Nurnber oi F�cquisition if Newly
<br /> � Purr.hased
<br /> , ., ....... .... _ �. ..._. ���f��"��C� -.�._... ,.... ����d�7����-. �_�,,,._f� �s✓�
<br /> ���. �� _
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<br /> ,�, r�a.e 'r' d r� . '�s, t 1. '�Lr r. �-jlc%C/�a,l��-?`��- /'-Cv /D r;��r.5
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<br /> `�/77C'' ... ta ��C �/I�'r-�� 1Cr i/� �Ll�/..3�1C� ...._ F )
<br /> �.. a3-�ib w��h�� �.
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<br /> ��r �'��. c" r _�T�-��l�r ls[Gt I�%�_!�` c�G��
<br /> .5 c� _ _....
<br /> _ .___..
<br /> Nature of�f Motor Vehicle: Are the motor vchrcles used
<br /> �Agricultural/Horticuliural ❑Educational �.Religious �Charitable �Cernetery
<br /> exclusively as indicated7
<br /> Give detailed description ol use,including an explanation if mulfiple classi�ications exist'
<br /> �YES �NO
<br /> 7Y T!!l)l.Q�/�CL-! /'SGC111L�I�Gti�.� ���5 If e
<br /> �I�j..l�J,��/'���G � � � � , .:�
<br /> � �..�ec�� �� �f'�..5�_it�rl,�!c'�s n(�c�Lj h��. ��.��� "-,y����
<br /> in '7�,� eL�Y� t��� �"�' �
<br /> �.�. ��`���
<br /> �� ��"cc5�'��.5 i2
<br /> ) i" �,a �� ���
<br /> � Under penalties of law,I declare that I have examined this applicalion and,to the best of my knowledge and belief,it is corr �t and,,.t �,TM T
<br /> complete.1 also declare that I am duly authorized to sign this exemption application,and that the organization ownin said properj}r-d e's',not .,-:�rFic�
<br /> d' criminate in membership or employment based on race,color,or national origin. r`' �' _ ���g��:�F::cA
<br /> 9 j.... , �
<br /> si n F
<br /> _ .�,���. _ � a�:,� _ ��. ;-� � t. ll_./� lG
<br /> .G��' __ _ -
<br /> here ��-� / Title �ate
<br /> _� _. __ .._ -. . __..
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<br /> ._ . _ __
<br /> Aut nriz FOR COUNTYTR�ASURER'S RECOMMENDATION
<br /> �_...
<br /> �.--... -----... ._. __....,.-- .. _.
<br /> _ _..... ._ - -- _ _. ,....�
<br /> �°'� COMMENTS �..S..S // '�.C7oZ._J __. _.._ � -
<br /> �]APPF�OVAL . _ _ ,...
<br /> ❑ DISAPPROVAL . _ __.
<br /> � ..1'�'' '�-� _._ _. �i --�'� -�'�
<br /> --_ ---- - ----
<br /> Signature of Cbunty Treasurer Date
<br /> _ —�.
<br /> _... .. _ _,�
<br /> FOR COUNTY BOARp OF EDUALIZATION USE ONLY
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<br /> [�APPROVAL COMMENTS: _ _. _ _.__,. ._. ......,._
<br /> t� ,
<br /> [] DISAPPROVAL _.,. _.� �t.. ....� _
<br /> I �
<br /> , _ _ ��"�"-
<br /> Aut ri�edSi�� " •' �._. _._ .....,.—
<br /> I-- Fnaturer � � Uate
<br /> _...,_.. . _�.—.. _ . l )( -.
<br /> Nebraska Department of Revenue Authorized by Nab.Rev.Slal§77-.7.D2� c)(d),§GO-3,165§603,789
<br /> 96-253-2006 Rev.5-2009 Supeisedes 9Fi-253��2006 Rev.71-20oe
<br /> PLEASE MAKE A COPY FOR YOUR FiEGORDS
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