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�—° 2011
<br /> -ros�Fi�.�owirr� Application for Exemption FORM
<br /> YOUR COUNTY from MotorVehicleTaxes
<br /> TR�ASURER by Qualifying Nonprofit Organizations (�C7
<br /> •Read instructions on reverse side "�
<br /> _...... . _.,.._._ _..,... _. _ _,.._.-- -- --
<br /> .....—
<br /> Applicant's Name County Type o(Ownership
<br /> SALVATION AR�IY R�L �Nonprniit
<br /> Street v...�...._ ................_...,_,. ,,.-- - ..., ... __..._
<br /> r pther Mailing Address Counly Nurnber Corporation
<br /> $1$ tid 312D ST 40
<br /> __..._....__.. __ ___ --- --......_....�_...---..._ ❑other(specify):
<br /> _..— _._.._
<br /> Gity State Zip Code State Where Incorporated
<br /> GRAND IST.AND 1�E 68$O1 NE -( ����..___
<br /> -- - .--- -...._ ..
<br /> It�c�ntify�flicers,Directors,or Partners __� g a ����r- 5 � ���
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<br /> _.__ ,�:.... . . . ....._
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<br /> Title Name,Address,Cuy,State,Zip Code
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<br /> LIST SPECIFIC DESCRIPTION OF THE MOTOR VEHICLES .
<br /> •Attach additional sheet if necessary
<br /> _ _ ..._._._.------- _.---- ___...,._..
<br /> Reyistration Date or Date
<br /> Vehide Make Model Year Body Type Vehicle Identification Number of Acquisition ii Newly
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<br /> �'urchased
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<br /> Nature of Use of Motor Vehicl�: Are the motor vehicles used
<br /> �AgriculturaVHorticuliural �Educational �Religious �Charitable �Cemetery exclusively as indicated?
<br /> Give detailed d�scription of use,including an explanation if multiple classifications exisl: �YES �ND
<br /> �1 G..�� �� �t1�- C�.'ro� o � ��olql-C �-c'orti-. ��..._rt��-. n-.�c� �Iww�6ar����
<br /> � / If No,give
<br /> C�OVY�JYIv�vti�t^y ��4'`'`� �$'r C.�•�-r�� [rtiG�,v� ��-C 5 . �a C7 -�O G�.rv.{ w
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<br /> ,�-�rv� L'.Cs-w�A� �� �.-S� V e.�_�.t 5
<br /> a, s �-:��. �.1�a a s , �,�-�d6��, �a�-�-� �P;�.�< <.,�, �,..� �.�.�::,�.r NpV 1 8 ZOI�
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<br /> Under penalties of law,I declare that I have examined this applicativn and,tp the best of my knowledge a beliei,it ig'�r�kJSTW't5 OFFIC�
<br /> complete.I also declare that I am du�y authorixed to sign this cxemption application,and that the organization owni said f8 t�"21tfeSAak�E),NiSt�fz,nKSA
<br /> discriminate in membership vr employment based on race,color,or nalional origin.
<br /> S�9 n � �����..y�� .�.__ - e
<br /> Authorize � � � �� �� � � L�-' �
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<br /> here _r--- .. . - - --.__._ _
<br /> Signature Title Date
<br /> __.._ __._ __' _ __..._ --- ---- -----
<br /> FOR COUNTYTREASURER'S RECOMMENDATION
<br /> _ � ...,._�---
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<br /> �]APPROVAL COMMENTS:��� �� �D°�
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<br /> �1�15APPROVAL _
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<br /> � i rr�ture of County Treasurer Date
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<br /> � FOR COUN7Y BOARD OF EpUALIZATION USE pNLY �
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<br /> �APPROVAL C4MMENTS�
<br /> ❑DISAPPRQVAL � � � � _ � _._.,._
<br /> -r �- '� ',�.�_..
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<br /> Aut}iorized Signature �- � Dale
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<br /> Nebraska�epe.._ ....,...__._.._ _..._,_._,_.... _..m.,....._......�.........----._._........_...-__.m......._...�.,._ _—._...._..
<br /> ��rtment or r�evenue Autnorized by Neb.Rev.Stal.§77•2D2(1)(c)(d),§60-3,1p5§LU-3,169
<br /> 9G-253•2oD6 Rev.5-2009 Supersedes 96�253-2006 Rev.11-20D8
<br /> PLEASE MAKE A CQPY FOR YOUR RECpRpS
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