|
Application for Exemption Fo��2°�1
<br /> TO BE FILED WITH from MotOrVBhideTaxe5
<br /> YQUR GOUN7Y by Qualifying Nonprofit Organizations (�CJ'�''
<br /> TREASURER •Read instructions on reverse side
<br /> __......._ ----.... __.....�
<br /> � � � Count Type ot Ownership
<br /> —_..—_.._ .. , y
<br /> ApplicanYs Name
<br /> 1'RINIT�I LU�C3�.KAN SCH.00L 1�ALL ____ . 3�Nnnprotit
<br /> Street or 4ther Mailiny Address County Numbcr Corporation
<br /> Zn$ W j�� s� �F, ❑Other(specify):
<br /> Gity State Zip Code State Where Incorporated
<br /> GRANT7 TSLAND N� _.__.._ 68801 _ NE °
<br /> .-- .. _._. ---. ... --- _.
<br /> �dPntity Officers,Directors,or Partners
<br /> ., _._.. _._ _ ... _ . ._ -- - —._..
<br /> _. _,_.
<br /> Title Name,Address,Gity,State,Zip Code
<br /> � --- -..,-- - _ _.. - --- -- _. ..
<br /> ��t��o!_�r ^� Yo` e.s�LLSL . en nA�_.�L .�a�r.lV� _._.�&�FrD/
<br /> _
<br /> �`_�S G.��Q��r LG1.r�/{t�n .��� �ir Gi� _._.. �'��� . (o�k(�3
<br /> -----
<br /> ����va,�.�._._��`r �Q.►�� _.�.2�si� r�� G`i N�. 6��_6�_
<br /> �Sc�►avl��� �a+`r __. .s��,ss��..�.�Lc�� /y�`��r E/ /i� ��sol.._
<br /> �
<br /> _ _._ ._ ---_ ___
<br /> _.. __._.
<br /> LIS7 SPECiFIC qESCRIPTION OF7HE MOTOR VEHICLES
<br /> Attach additivnal sheet if necessery
<br /> __ ._ - ..,. _ . _. _ . _._
<br /> Registration Date or Date
<br /> Vehicle Make —�odc�l Year eody 7ype Vehicl�Identification NumbEr of Acquisition if Newly
<br /> purche�ed
<br /> ��6;�d _. .�... v.�. � ...� V,'S;Q� �cK uz��251_� - 2 �.��_.��
<br /> ._. _ _. --_. __. _._. ._. -.-- ---- ....
<br /> Nature of Use of Motor Vehicle: Are the motor vehicles used
<br /> �Agricultural/Horticulturai �Educational �eliginus �Charitable �Cemetery exclusively as indicated?
<br /> Give detailed description ut use,including an explanation if multiple classifications exist: �ES �NO
<br /> �,�....... �
<br /> .,s�,����.,,�
<br /> n / / � If Nv,�ive p� e `'Y ��n %
<br /> /'�GT1 V��t� �LtS "' ����?5�or L�ii�q S C12479-� t�.<.�Y�'��'
<br /> �,,y� Li�i�eL ,�yz e rrZ 6�r� �v r C� G-�i'v i7i�s
<br /> ,. , , �7';�Q
<br /> F�r.,�.,,c:..,-.�_}r.,�
<br /> m Under penalties ot law,I declare that(have examined this appiication and,to the best of my knowledg and belief��is'�Orrect and�` '� ��q
<br /> complete.i also declare that I am duly autharized to sign this exemption application,and that the organization o n�gg�,�rd`.pr'opei�y�d.oes-noY..=`---�•--
<br /> discriminate in membership or empioyment based on race,color,or national origin.
<br /> �`n ,� �.u-�-ef.--�r�. �C1z a o--2
<br /> sign ��'" ��- �1 - �Z -�U
<br /> here �� rized Signature / Title � Date
<br /> �... _. _... _.. �. _r �
<br /> �QR COUN7YTREASURER'5 R�COMMENDATION
<br /> �°�PR�VAL COMMENTS: ._��✓�-S �����0�"
<br /> �DISAPPRQVAL _..,.
<br /> � �i'. _.`0�
<br /> _.�__.. . ._
<br /> Siyn�I of County Treasurer C7ate
<br /> . f FOR COUNTY BOARD OF EdUALIZA - _ _.._ __ _..._
<br /> .�_.._.__ •
<br /> TIQN IJSE ONI�Y
<br /> �_T . �. __... _.. .. .
<br /> ❑APF'NOVAL COMMENTS: --- _...,._— _, _.
<br /> #
<br /> ❑DISAPPROVAL _.._ .. � � ! � _... �.�� ...�.....__..... ---- —...._
<br /> � � � � �� __. .
<br /> r ,/ �
<br /> .
<br /> A Ihorized Signature T 1]ate
<br /> i
<br /> _. .. ............._ ........... .......---- �� Aut orizad by Nr.b.Rev.SI�L§77-202(1�..._. __.......__�
<br /> N?braska Departmenl of Ravenue (c)(d),§60-3,185§G03,189
<br /> 96-253-?O�6f-iev.5-2�09 Supersades 96-253-2006 Rev.11-200R
<br /> PLEASE MAKE A COPY FOR YOUR REGORDS
<br />
|