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TO EFILEDWITH Application for Exemption FORM1
<br /> vOUR cOUNTY from Motor Vehicle Taxes
<br /> TR�ASUR�R by�ualifying Nonprofit Qrganizativns �C�
<br /> •Read instructions on reverse side ��
<br /> _.,...., .. _....... ...._ _........-----...............----------- _
<br /> ApplicanYs Namo Gounty Type of Dwnership
<br /> SENIpR CI�'IZENS INf]USTRI�S INC �,�,
<br /> ._,.....,.-- .. _ �Nonprofit
<br /> -- .. .._._. _.
<br /> Street or Oiher Mailin Address �
<br /> 9 Gounty Number Corporation
<br /> 304 � 31ZD ST 4p �dther(speci(y)
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<br /> Ciry State Zip Code State Where Incorporated
<br /> GRA,NI) ISLAND NE 68801 13E _
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<br /> __
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<br /> Identify bfficers,Diroctors,or Partnors
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<br /> Title Name,Address City,State Zip Code
<br /> � _... —_
<br /> ._�.._j.... � — _ __.. ---- __.._ . _—_
<br /> ��� L1� _ ,_ __...--- �--- .. _... _.._.
<br /> _...._.. ...._.. __ _...--. _.___. _ _... ,, _._._ . __._ �
<br /> LIST SPECIFIG��SCRIPTION OFTHE MQTpR V�HICLES
<br /> Attach additivnal sheet if necessary
<br /> � .... __ -- —..__.._, --- --....
<br /> Re�islration Date or Date
<br /> Vehicle Make Model Year [Sody Type Vehicle Identification Number of Ar,quisition if Newly
<br /> Purchased
<br /> _....... _._... .._. . .._—.— _ ----
<br /> �,
<br /> ..���f T _. __ �.
<br /> /71 ..,__ _ _...1,..�. . . -__ _ �. -- /� _
<br /> _E l�� � _._ '"'� --,m
<br /> — ---------._� --- -- . _�.
<br /> ----
<br /> Nature of Use of Mo1or Vehicle: Are the motor vehlcles used
<br /> �Agricultural/Horticultural �Educationat �Religious hf I Charitable �Ceinetery exclusively as indicated?
<br /> r.�.,
<br /> Give detailed descripti�m of usc,including an explanation if multiple classifications exist: YES �NO
<br /> �'C`O V 1�L°.S ��l+1uQX'� c�-�? `m�ls � u�hee.`s If No,giv „ '�'d��`•�' ' /
<br /> U�a 1`�-�-1�n �c�11L� ��'�.
<br /> �
<br /> ' N�V i 9 �1a
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<br /> Under penatties of law,I declare that I have examined this application and,to the best of my knowledge np belief,i �t
<br /> complete.1 also declare that I am duly authorized to sign this exemption application,and that the organization ow ing said� ���A N�f3RAKSA
<br /> discriminate in membership or employment based on race,color,or national origin.
<br /> i
<br /> s ig n � ` //�/��
<br /> here .----- -- . _._ . .--
<br /> Authorized Signature itl Date
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<br /> FOR COUNTYTREASURER'S RECOMMENDATIQN
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<br /> �APPROVAL COMMENTS; ��_�._[� 6 `��� ���
<br /> U DISAPPROVAL
<br /> _._..._._ __.,-- -- ,. __.__ - — _._
<br /> ���j �'/ /y �l
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<br /> Signature ot County Treasurer Date
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<br /> FOR COUN7Y BOARD OF EQUALIZATION USE QNLY
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<br /> �]APPROVAL � CpMMENTS: _._
<br /> t� _ .._,. ..
<br /> ❑ DISAPPNOVAL ----._,,..._ '.. d.. ! /? ^ � A
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<br /> � r' � � °f �
<br /> � 7 �
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<br /> Authorized Siynature j' Date
<br /> 4
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<br /> Nebraska De artment of f�cvenue. '������ �'��
<br /> p Autnorized by Neh,Rev.Slat.§77-202�1)(c)(d),§60-3,185§60�3,169
<br /> 96-253•2006 Hev.5-2009 Supersedes 96-253-2006 Rev.11-2008
<br /> PLEASE MAKE A COPY FOR YOUR RECQRDS
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