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roBE����nwirH App��ication �or Exemption <br /> YouA COUNT'Y fram MotorVehicieTaxes �ORM <br /> TREASURER by G2uai"rfying Nonprofit Organixations 4G7 <br /> •Read ir�structions un reverse side J� <br /> AppiicanYs ame /� �� County Type of Ownership <br /> / / J <br /> t�i G� ! i t3� �` 1'�`�i� — � ��� �L L_ NonproFit <br /> Streot or Ther Maiiing Addr ss Cpunty Number �COrporation <br /> ___ ._/`-��� _ «Y]�G���/i!C,�1. �� �`�' �1rJ � .._._...__..._ �� ❑qther(specify): <br /> City . ' State Zip Code State Where In�cprporated <br /> C� �� ti � tS ��ti <br /> �, �.1� �; B��c�� � <br /> Icientify Officers,pirectqrs,pr Partners <br /> 7itle ��,4ddress,Ci State,Zi � � <br /> h', P <br /> �r Y��S:.:w��-- r �o�..£�n 4�- l_l�, �1�T c}� ��� S �r-G .��r.� � .+�1 <br /> ����__ � - � � __�z- ��� ��f z�,<- � r��- � � . f � � ���3 <br /> � �, _.r :m'� r�Ca _S���sa 1��!�%(? .j� _�, .. c?- ., - - <br /> r�� �u' ?._ _�'.__._� �� �: -�' .rF � ��'�'' �' <br /> �� �� � � LIST SPECIFIC DESCHfPT'ION OFTHE MOTOR V�HICLES W ^W ~Y� <br /> •Attach additional sheet if neeessary <br /> � Registration pate or Date <br /> Vehicle Make Model Year Body Type V�hicle Identificatian Number of Acquisition it Newly <br /> Purchased <br /> -T ._..�_....___.__ <br /> .�. ��n c �...._ 2 t��� .. � °i '}: �.�.R� � �N_,�_k i!��H,�c���a5 �� �' �� <br /> .__._._ _.._ �`I __._.._.__..��...,.._ �.. <br /> Nature af Use of Motor V�hicle: T� ��H�� Are Yhe mptor vehicles used <br /> �AgricwlturaWk�orticuftural �Fduca6onal �Religious �Charitable �Cemetery exclusively as indicated? <br /> G detailed description of use,incfuding an expianatiqn if multipl ctessi5cations e�ost �YFS �NO <br /> 1 <br /> l'�11� � :L'!e �.� " r Y1�n �' �'' ` aG� ��b'r'1 S' If No,9�v �"' :ee % <br /> ��i�S ��e � C `� � --� r,.,e 1,,�, � �;� <br /> r(� � f � ` <br /> ,\�//� �'1, l��l (�'-- �`��' I�Cc h C�..� 7til �]'v� 1�i i1�h � . <br /> V � V � '� Y 1 �1`��� r ' -` <br /> ���` � � �UJI <br /> . ' <br /> Under penalties pf�aw,1 deGare that i have examined this appiication and,to the taest af my knewledge and beli@f��T'is���t:3,� r���^� <br /> com lete.l alscr de�tar that i am du1 a horrzed tq si n this exem �on a lication,and that the or nizatipn own�n sa� TS `�`��A <br /> P Y 9 Pt pP 9� J p�ty-dr�es <br /> -,�_., <br /> discriminate in mem�ip pr e nt based on race,color,or.national origin. <br /> ,' ��� <br /> �.�---� <br /> , � ,,, <br /> � <br /> WJ <br /> 51�17 _ - —j ' / � <br /> �. � _ �, ' Cc�S � w~�— �l". <br /> �._...._.....-- --.,...---=-.:......_.._ <br /> here �zed 5ignature mmTw� Tr�e �� Date �� �� <br /> _�___.________�m..._____..___ _____ �..___. <br /> �OR COUNTYTREASURER'S RECQMMEN�ATION <br /> �APPROVAL CQMMENTS: � �� � �" a � �.._ ' _�� <br /> ❑DISAPPRQVAL _�._... �,.__ _� <br /> �.�_ ,���.i-�-` d---� ` -`\ <br /> \ <br /> Si ature o County Treasurer T �ate <br /> �OR COUNTY BOAR EQUALIZATION USE ONLY �� T�� �� <br /> �APPROVAL COMM�NTS: �_ <br /> � <br /> []�15APPROVAL _ ,_ <br /> t � . <br /> "u orized Signa ur pate <br /> Nebraska 17apartmant of Flevenue � Autti�nzed 6y Neb.Aev.StBi§77-209.(1)(c)(d),§60�,185§60�,188 <br /> 96-253-2DD6 Rev.5-2D(19 SuporsAdas 96-259-1DD6 Rcv.ti-20D8 <br /> PLEAS�MAKE A COPY FQR YOUR RECbRDS <br />