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TO B�FILEDWITH Application for Exemption FoRM <br /> from Motor Vehicle Taxes <br /> YOUR COUNTY by Qualifying Nonprofit Organizations ,45"7 <br /> TREASUREFi •Read instructions on reverse side <br /> _,.__. __ - -- <br /> -- - <br /> Ap IicanYs Name County Type of Ownership <br /> ���A..)��,_. t� �C?ld��r���l.�����C� ��.. �Nonpi ofit <br /> S1ree1 or pther Mailing Address County Number Corporation <br /> �.U� .��.�y�..�L.J_��,`_S2S��. . _. .... _.._ `--t�_ L�Other(specify): <br /> C� � � � Stata Zip Code State Where Incorporated <br /> ���.aL1��51_�R�_�_��-- . ����� _ �`�. <br /> Identify OfficPrs,Directors,or Partners � <br /> _.., __. _ .. —_. <br /> —. - —... . - ---- _._ . . <br /> Cdle Name,Address,City,5tate,Zip Code <br /> —.����� _ _ _.. <br /> _ - -.. _... .-- --- <br /> LIST SPECIFIC DESCI�IPTION OFTHE MOTOR VEHICLES <br /> C •Attach additional sheet if necessary <br /> _ _ <br /> __ _ _ _ __ _ __ _ <br /> Flegistration Pate or Date <br /> Vehicle Make Model Year Body Type Vehicle Ideriti(ication Number of Acyuisition if Newly <br /> PlllCh85Bd _ <br /> . ._ ..... .. <br /> .... . ._ .... ..._ ..._.. <br /> �nu��TQL..._ _ �q�.. _._ `r f�.� L�_ _ 1DYy��3�S��oo� ca -- - .-.11_ <br /> Srt'c�_l��-HT�I . 1 g9-�-.. A1�fZ . YV iA 53�.3�1�� _c�2��,l— <br /> --�A:t�m�i.1� ��.. . `r' . r��.2 _l P."r"o� �k_5.�1�5_ _...o�._. �.� — <br /> -- - - - -. _. -- - -- _ _ <br /> _.. _ _ a,w,s�~�o��t�' <br /> "��c.� �DQ3 _. ._��A��_ __ H P 5�K93�{.!� `� �n��-s�..�°-� <br /> _. _ _ - -- <br /> Nature oi Use of Mo1or Vehicle. Are the motor vehicles u e <br /> n Agricultural/Horticultural �Educatipnal ❑Religious r]Charitable L]Cemelery <br /> exclusrvely as�ndicated? <br /> Glve detailed description of use,inoluding an explanation if multiple classitications exist: _ �YES [�NO <br /> ��.�^� ��t�66�-�-�. ��-_-.Q�[��jl[1�1�26.�5 .�_.. If No,give����� <br /> rr�..����ci1o.���� -- <br /> �Q���Q.��� <br /> ��.��c��. " �� s ����•-�-� <br /> �n 4�c��e.��_4�.�������k�-- -�-- �� �� Ak� F�B 2 � �Oi1 <br /> C,�`�.e-n,k5 �a_��� G�'1�eti����r►w+��s_�.�_-�.r�n�.�.�. � -- - _ <br /> Under pehalties of law,I declare that I have examined this application and,to the b'ert of my knowledge �d belief,it edr4@�1-�UNTY <br /> complele.1 alsa declare that 1 am duty authorized to sign this exemption application,and that ihe organizatipn ow ing said��r�"o��t�s OFFtCE <br /> discriminate in membership or employment based on race,color,or national origin. +�1��SLAND,NE8F2ASKA <br /> S�gn �Authorize gnature_,, — _ '7'itle � � O -- Date�i.�_ <br /> here <br /> _ _._ -- - <br /> _ ... <br /> FOR COUNTYTREASURER'S RECOMMENDATION <br /> _._... .. <br /> _ <br /> �APPROVAL CQMMENTS�� �h� � �� � �C' �` <br /> _ --- -.. . _.. ..--�- --- --- <br /> �pISAPPROVAL -- -- <br /> � , , �- _..__._�._. � _��aw� \ <br /> _.�. �-�.._ c�----- ��-�_ __. _. <br /> 'S nature County Treasurer `� I7ate <br /> -.. _ _. _. <br /> -- - --- - _ � <br /> � FOR COUNTY�BOA G-OF EQUALIZATION USE ONI.Y <br /> '�J AF'F'ROVAI. COMMENI'S' —. __._ _. <br /> V� <br /> s <br /> []DISAPPRDVAL —.. ._ / • _ / _ . ' , <br /> . _� � �- _ �-����� <br /> Iuthorizod Sig ature / p�t <br /> — _ <br /> 96-263-20U6 Rev.5- V Authorized by Neb.Rav.StaL§77-202(1)(c)(d),§GO-3,185§60•3,189 <br /> Nedrasku�epartmenl of Fqvenue <br /> 2009 Supersedes�J6-253-2006 pev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR REGbRDS <br />