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Application for Exemption �o'1
<br /> TO 6E FILECt WITH fram Motor Vehicle Taxes
<br /> YOUR COUNTY qy Qualifying Nonprofit Organizations 4CJ°�'
<br /> 7R�ASURER •Read instructions on reverse side
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<br /> ApplicanYs Name County Type of Ownership
<br /> OV�IZI,AT1nTRAIT,S COUNCIL BOX SCQUTS Ok' AMF•RICA �y7• �]Non rufit
<br /> ___ _..,. _...�.-- -... . p
<br /> Sircet or�ther Mailing Address Courny Nurnber Corporation
<br /> 2$08 O'FI.ANNAGAN PO BOX I�E7 J. _ �FO ______ �Oiher(specity):
<br /> City � State Zip Code State Where Incorporated
<br /> GKAND ISLAND NE 68802 N"E ----------........._
<br /> _ . . _
<br /> _..._......
<br /> Identify�fficers Directors,or Partners
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<br /> — -----.
<br /> Title Name,Address,Cily,State,Zip Code
<br /> �-�s �P�- ....�-----. � h ���.��.� �a�S cn;��,,� GY�1���� ��.[���o .__ _.
<br /> �a �t P� ..., n bl�_. \3'a3 N r��. �.�So � � ,�s-� �5 �-? �8cta 1 ------
<br /> _... ----.._._ __. _ _._ ._ �
<br /> LIST SPECIFIC DESCRIPTION OF�7HE MOTOR VEHICLES
<br /> �Attach additinnal sheet if necessary
<br /> _.... _...
<br /> _ _. -- ---
<br /> �"" - - Registration Date or Date
<br /> Vehicle Make Model Year Body Type Vehicle Identi(icatiun NumGer of Acyuisition i(Newly
<br /> — .... . _....
<br /> Purchased
<br /> ��'�L _ _... �..��_ (C�,.�o) U�' G1S RXr lo�o� �-���U--.._...
<br /> ao�,e �'���.w�:__ :�.�o$ _rn-,�.: v�� _-- ����►��4��3���� _.._7��,�a 9
<br /> Nature of Use of Moto _....,._ _,_.. __._._...� - _._...... _.__._._...,..
<br /> r Vehicle: Are the motor vehicles used
<br /> �Ac�ricultural/Hrnjiculturat /�Educational �Religious �Charitable �Cemetery cxclusively as indicated?
<br /> ve-
<br /> Give detailed description ot use,including an explanation if multiple classifications exlst: �YES �Np
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<br /> ���O UG-f\- ��'�`K•` V�`��=Ae`i ���000,,, a, ��' �
<br /> If No.y����� �
<br /> �`91v1� W���r � 1\v��O-` �d�'(��(� �U� �01^�-� MO,:r��°n�nc�
<br /> q� d$��r��;a r-S y�rc�r �0-�-� ��C �� 2UjU
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<br /> �� Under penalties�vf lew,I declare that I have examined this application and,tv the best of my knowledg end belief,'.�i�j��oY� Rr^�t��tCE
<br /> c lete.I also declare that I am duly authorixed tv sign this exemption application,and that the organization o ning sai�p�cyty���e�siSq��g��;SA
<br /> isc iminaY 'n membership or em I ent based on race,eolor,or national origin.
<br /> � ._ �,. ._.- --- �-'�-�e.t/1 C����`4� ---,. _.._._.�
<br /> sign � Ja/
<br /> here Auihorized Signature 7itle pate
<br /> _. .. ._ _ .._
<br /> FOR COUNTYTREASURER'S RECOMMENDATION
<br /> C. __ _ - _ ---- .---
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<br /> APPROVAL COMMENTS. ��'• � �' ` `" -
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<br /> ❑ D15APPNOVAL ----•--• ---- -
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<br /> �r �'�... � '.. .� , ._...... — /�r�lr cw/. �,�t'�,.
<br /> Sig/ nature of County Treasurer Date
<br /> . . _.. _.., _. ._. _.. .
<br /> FOR COUNTY BOARD OF EQUALIZATION L1SE ONLY
<br /> �APPROVAL COMMENTS: .....__ _ ......... _.._ ...,___... . ,,.--
<br /> [�DISAf'PF�QVAL � _ f/. � � f � � P �
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<br /> �Authorized Slgnature � Date
<br /> Nebraska�epa«mant of Revenua Au�horized by Neb.Rev.StaL§77-202(1)(c)(d),§60-3,1A5§CO-3,9$9
<br /> 96-293-2006 Rev.5-2009 Supersede5 9f+-253•2UOG RBV.11•20U8
<br /> PLEASE MAKE A GOPY FOR YOUF�RECORDS
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