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Application for Exemption �oRM
<br /> TO BE FILED WITH from Motor Vehicle Taxes
<br /> YOUR GAUN7Y by pualifying Nonprofit Organizations 457
<br /> TREASURER •Read instructions on reverse side
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<br /> Applicanl's Name County '1'ype of Ownership
<br /> ORPHARd GRArN TRAIN HATyT� _.....,.. �]tvonprotit
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<br /> Street or 01her Mailing Address Gounty Num6er Cnrporation
<br /> 427 l�b SHAT)X BFND 1ZD — (=RAND IS�..AND PO BOX 1565 40 _..,,._ ❑Other(specily):
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<br /> City State Zip Gode State Where Incorporated
<br /> ]�ASTINGS NE 68902 _ N�:
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<br /> Identify Of�ic,Prs,Directors or Partners __ _ __ _
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<br /> Title Name,Address,City State,Zip Code
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<br /> D�/�'�� d'77/t�r�`,''��� . G6°�� c.�Ja,.r`�r� � ---.5'T F1-��t��ys..�� R /4/�-Nt� �,�.�i�� �G!�_ �c�
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<br /> LIST SPEGIFIC DESCRIPTION OFTHE MO70R VEHICLES
<br /> � Vehicle Identiflcatian Number �uA�c
<br /> �-" -�- y 1 stration Date or Date
<br /> Attach ad it�ona s ee i necessar
<br /> �%shicl?Make Mvdel Year 8ody Type I quisition ii Newly
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<br /> hasea
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<br /> Nature of Use.of Motor Vehicle: Are the motor vehicles used
<br /> �AgriculturallHorticultural �Educational �Religious �Charitable �Ceme�ery
<br /> exclusively as indicated?
<br /> Give detailed descriptinn of use,including an explanaiion if multiple classifications exist: �'YES �N�
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<br /> ~ Under penalties of law,I declare that 1 have examined this application and,to the best of my knowledge a d belief,it is correct and
<br /> complete.I also declare that I am duly authorixed to sign this exemption application,and thai thc organizativn own ng said propert h18��UNTY
<br /> discriminate in membership or employment based on race,calor,or national origin. tR�ASURERS bFFIG�
<br /> Gf+�aJ.'��l Icl.n�ti':�.'vE=oRASFfA
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<br /> sign � � ��- `�-��-la
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<br /> here Autharized Sign re � Titler Date
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<br /> FOR G^L�!VT'YTRE!lSURER'S RECA^J!.^.9��!DATICN
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<br /> [f]APPROVAL COMMENTS:��-J. .����j __..,,,..--- _....._ ,
<br /> ❑DISAPPROVAL ---_ - --.. ,--- _._..,......._ �
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<br /> Si nature of Count Treasurer Pate
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<br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY
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<br /> ❑APPROVAL COMMENTS: —_.._ ---._..._..._. _.... .,.,.._ �
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<br /> [�] bISAPPROVAL - � '� � � --°- -
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<br /> I Authorized Signature � � Date
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<br /> Nebraska Deparuneni of Revenue AUthorized by NeG.Rev.5121,§77-202(1)(c)(d),§60-3,185§GO-3,1A9
<br /> 96-253-2006 Rev.5-2009 Supersedes 96-253-200G Rev.11-`100A
<br /> pLEASE MAK[A COPY FOR Y�UFi RECbRDS
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