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Application �or Exemption oaM
<br /> 'f0 B�Fi�.��wrrH from MotorVehicleTaxes
<br /> YOUR CQUNTY by Quafifying Nonprofit Organizations 4,57
<br /> 7REA5URER •Fiead instructions on reverse side
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<br /> ApplicanYs Name County 7ype of Ownership
<br /> SEIZVAN"TS OF MARY SR RITA KOLBET HALL _T �Non�rofit
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<br /> Street or Other Mailing Address County Num6er Corporation
<br /> 821 ORI,EAI�S DR 40 _.,, ❑Other(speciry):
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<br /> City State Zip Code State Where Incorporated
<br /> GRANll ISI�AND NE 68803 NF _.. .......
<br /> . — _. . Name Add
<br /> Identify Dfficers,Direc'tors,or Partners
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<br /> LIST SPECIFIC DESCRIPTION OF 7HE MOTpR VEHICLES
<br /> •Attach additionat sheet if necessary
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<br /> - - " Regislration Date or Date
<br /> Vehicle Make Model Year E3ody Typc Vehicle Identificatipn Number of Acyuisition if Newly
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<br /> Nature of U ...._— _,....._.. ---. .. __ _
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<br /> se of Motor Vehicle: Are tlie motor vehicles used
<br /> �AgrieulturaVMorticultural �Educational �Religinu; �CY�aritable �Cemetery exclusively as indicated?
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<br /> Give detailed description of use,including an explanation if multiple classifications exist: �1'ES �ND
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<br /> Under penalties of law,I deelare that I have examined this flpplication and,to the best of my knowledge nd belief it�;�orrect•.ar�d :'F'C�
<br /> complete.I also declare that 1 am duly authorized to sign this exemption application,and that the vrganization o ing saic�operty,doe.s,not;��w�,;-_� ::'•.;'� k^,,,�,
<br /> discriminate in membership or employment based on race,color,or national origin. �� �
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<br /> here Authorized Signature 7itte Date
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<br /> FOR COUNTY TREASUFiER'S RECOMMENDATION
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<br /> _ APPROVAL COPJIMENTS: �I _.�?�-'_..._ I/� p� �`�-�_—...,..
<br /> ❑bISAPPROVA�. ---._..__..... ...._.. _..._.... .-- ----,........
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<br /> Signature of County Trea urer �ate
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<br /> � FOR COUN7Y BOARD OF EQUALIZATION lJSE ONLY
<br /> �APPROVAL COMMENTS: ---. ... _.. .. _.__......._...._.__.__. __...__...._........ ........_
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<br /> I Au horized Signature � Date
<br /> d 60•3,185§60-3,189
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<br /> J ' � AUlhorized b Neb.Hev.SIaL§'i7-2n2 1)(c)( ),§
<br /> NebraskB D2pBrtmont o(R2VBnU6 y �
<br /> 9G-253-2006 Rev.5-2009 Supersedes96-253-2006 Rev.11•2008
<br /> PLEASE MAKE A COPY FOR YQUR RECORDS
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