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Application fior Exemption FORM�11
<br /> Tp BE FILEDwITH from MotorVehicle7axes
<br /> 'YOUR COUNTY
<br /> TR�ASURER by Qualifying Nonprofit Organizations 4CJ'�'
<br /> •Read instructions on reverse side
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<br /> ` Count T e ot Ownershi
<br /> ApplicanYs Name Y YP P
<br /> YWCA OF GRAT7ll IST�AN17 t1ALL �,]rvonprofit
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<br /> Street or Other Mailing Address County Number Corporafion
<br /> Z 11 E F'03�N�R PARK Rll _40___ ❑Other(specify):
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<br /> City State Xip Code Staie Where Incorporated
<br /> GItAND 151,AND NF: ...�$$Ql. -- . .___--
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<br /> IdenTify O(fic�rs,Directors,or Partners
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<br /> Title Name,Address,City,State Zip Code
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<br /> LI57 Sp�CIFIC pESCRIPTION OFTHE MOTQR VEHICLES
<br /> •AYtech additional sheet if necessary
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<br /> Reyistration Date or Date
<br /> Vehicic Make Model Year Body Type Vehicle Identificatiori Nurnh�cr of Acquisition ii Newly
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<br /> Nature of Use of Motor Vehicle: Are the mator vehicies used
<br /> �Agricultural/Horticultural �Educational �Religious Charitable �Cemetery exclusively as indicated?
<br /> Give detailed escription oi use,inr,luding an explanalion if multiple classifications exist: ; YES �Np
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<br /> Under penalties of law,I declare that I have examined this apptication and,to the best of my knowledge nd beiiei,it is � d�
<br /> complete.I also declare that i am duly authorized to sign this exemption application,and that the organization o ing said pr��c������'c�
<br /> discriminate in membership or emplayment based on race,color,or national origin. , C3R,o,NU ISLqNFJ,tU'-:BR ,('8p
<br /> sign ��' _�. �, ,,,� �z.. �/�����f i�� ;�'j;r���� �/ / %:
<br /> Auth ized Sig Z.t2. , 1 � ..�l�,�� -. .��,1-= ) --- -..... ,..'�..,...._
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<br /> here �� � e � ' Title `J �at
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<br /> � � ,f FQR COUNTYTREASURER'S REGQMMENDATION �
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<br /> �APPROVAL C�MMENTS: _ _... �.-�����r� J� ---._ _....._. „_...
<br /> [,DISAPPFIOVAL ......., ---...__ ...._...._.
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<br /> �Signature of Gounty Treasurer Uate w
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<br /> FOR COUN7Y BOARD OF E�UALIZATION US�ONLY
<br /> ❑APPRpVAL COMMENTS: ____.. ._
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<br /> U DISAPPROVAL __...,.._ �:_.... ._.. � '�—
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<br /> �AuthorizedSi nature //(_...... :.,. - "`� -----..._^ Da......._.._....._.......T_.._
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<br /> Nebr&ska Depariment of Fievenue Authoriz.d by NHb.Rev.5tat.§77•2p2(1)(c)(d),§60-3,1(35§6D-3,1p9
<br /> 96•253-2006 Rev.5-2DO9 6upersedes�36�53-2oU6 Rev.11-2008
<br /> PLEASE MAKE A COPY FQR YQUR RECORDS
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