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2011
<br /> Application for Exemption FORM
<br /> TO BE FILEDWI7H from MotorVehicleTaxes
<br /> YoUR COUNTY by Qualifying Nonprafit Organizations 45�
<br /> TFiEASURER •Read instructions on reverse side ----
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<br /> --- "- - Count Type af Ownership
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<br /> Applicant's Name
<br /> ABUI�DANT TaI�F. CARISTIAN CLrNTER ��L �Nonprafit
<br /> --...
<br /> ---.—.
<br /> - -- Gounty Number orppratipn
<br /> Street
<br /> or Other Maihng Address
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<br /> 3411 bd �AIDLEY AVE 40 L otner(spe��ry):
<br /> _ _—.
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<br /> Gity
<br /> —`—"— State Zip Code State Where Incorporalo
<br /> NF _.—._..
<br /> GR�D ISLAd�D NE _ �$$03 _— — _.. _. .— _
<br /> — �_—. — — ...—. ._
<br /> identify Officers,Dvectors,or Partners _ —.. - --— — —
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<br /> Tdle Name Address Cify,State Zip Code _
<br /> _,. ----- - _,. _ ..
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<br /> S�e P�r� C�r%�_ _ .��i ?_,�:rQ`r�i l�'e �2��f 1�� , F ���
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<br /> L15T SPECIFIC DESCftIPTION OF TME MOTOR VEMICLES
<br /> •Attach additional sheet if necessary __.
<br /> _—._. .
<br /> _,_._—_ —_...—_� —.
<br /> _. � -- Registration�ate or Date
<br /> Vehicle Make � Model Year � Body Type � Vehicle Identification Number oi Acqwsition if Newly
<br /> Purr.hla�ed
<br /> -- — �.._—.—,.. _.
<br /> _ —.,_ � - , _.
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<br /> Far�F�"�a..:�oQc� �'� ��?oa �r���r.E1�� ��"'`I_- � IF,�A�ti�_9.�l�i�o�. _ —__
<br /> J7o.�-99U_57q����.. l_L`�— ._S ;r��ri __ _��Su�C3�S�R��!��aJ. — --.
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<br /> _l�`, �.i/�. ..�'. 10403_C�D�.I ... 1�G�,y _._ �5��.n,_�����r�,; � / —.. - .-- ._
<br /> �(�.—L_.—���, t'fl���j—._ �C�!.�� r1 i Yl / �u� >n� y�'/r 1V u 5.��'�1�����.�.. _.. —
<br /> J � ....,-��_ �`X l�r!' ,�/11!��.�L/�.. H 7C,�i X rl .. _....--- �—
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<br /> //'��_ �,.— .— Are the mator vehicles used
<br /> Nature of Use of Motor Vehicle: exclusively as indicated?
<br /> ❑Agricultural/Horticultural u Educational �Religious ❑Charitable ❑Cemetery
<br /> /n/7.7 ��� � �� -1^U ��'!� �,1 YES CE NO
<br /> GivQ detailed description of use,including an explanation if multiple classifications exist: �.7.�i;�.!/I E't7� � �
<br /> _/�� s L�,,n ) �� �'� ,, /"r r;l 7����.. /Y',�°r.��L�7.��������"�_�..— If No,giv e%_�" -
<br /> �!�C � p�e c e�w,ros
<br /> _�p�;��7.r'�'_.%' ,_, r1,�.Sc?r�-l� -f�%s�� �'Ur�s.r?.hur� � -t� r�_._ ���������o
<br /> � /- ' r�? ��' r%l;�v%�'�. > '%' ._T ���'�s.
<br /> �;y�/..�7��/�%._�u. :�,a:n /'�.�. � — ,-. -.
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<br /> —_.—_ --. � _� p^ s qorae.F_t�!�}IV'fY
<br /> Under penalties of law,I ��lare that I have examined this application and,to the best of my knawled e nd belief,it i
<br /> complete.I also declare that I duly authorized to sign this exemption application,and that the or an�zation o ing said rd{leFty..d'4�hF?R�p�F�G'��A
<br /> discriminate in membership o employment based on race,color,or national origin.
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<br /> s�g ..._ ... � � ��,_ '�ci7-Ga�. _— _ 1�..l ri�c�
<br /> —. � — -- Title
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<br /> he�'E+'L'� --A rized Signalur�
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<br /> — '— FOR COUNTYTREASURER'S RECOMMEN�ATION
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<br /> � ���2�o�z-.-� . ._— ..
<br /> � APPROVAL
<br /> COMMEN7S: �P�
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<br /> [�piSAPPROVAL _
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<br /> Signature of County reasur�r �a��
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<br /> ( -- FOR COl1NTY BOAR�OF E�UALIZATION lJ _. .. -
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<br /> COMMENTS: — " —
<br /> ❑APPRQVAL _
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<br /> L��ISAPPROVAL --... —� —_ �- �.—.- , w
<br /> � � `� !G� r ``-...... , � .. = -�—..�/y:'I
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<br /> � � — �.._.._—. �.% -- f]ate �
<br /> A i ed ignature � r
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<br /> - ��" �— � AWriarized�y Neb.Rev.Stat§77•202(1)(c)(d),§60-3,185§60-3,189
<br /> Net�raska Depnrtment of Faevenue
<br /> 96-253-2006 Hev.5-2U09 Supersedes 96-259-2006 Rev.11•2008 PLEASE MAKE A COPY FOFi YOUR RECOR�S
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