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<br /> Application far Exemp#ion � �o�M
<br /> TO BE�IL�D WITH fram Motor Vehicle Taxes
<br /> YoUR COUNTY by Qualifying Nonprofit Organizations 457
<br /> TR�ASURER �Read instructipns on reverse side
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<br /> Appl�IcanYs�Name \ Gounty /� Type of Ownership
<br /> }��f'ry-ti a 1d�onprofit
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<br /> Street or Other Mailing Address � Gounty Number Corporation
<br /> �� � - �--�, _ 0 _ ❑Other(specify):
<br /> GitY " State Zip Code State Where In�porated
<br /> �_..�`C!!--T�. .._..��_.-��� -"�'.......- --._..
<br /> Identify Of(ieer;,Directors,or Partners
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<br /> Title Name,Address,City,State,7_ip Code
<br /> ._ _.,.... - _........ _ .. _... _. ....._
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<br /> A. G>r..fl s�C.c r . !l�'�?_w�K-$ I�l.-r5 _�[]ie-±d.vY.L C."'�f_�_iCY'r._�._. �.. _._.F..,. ��
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<br /> LI57 SPECIFIC IIESCRIP710N OF THE MOTOR VEHICLES
<br /> •Attach addrtional sheet if necessary
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<br /> -- Hegistration Da(e or�ate
<br /> Vehicle Make Model Year Body Type Vehicle Identification Number of Acquisition if Newly
<br /> Purchased
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<br /> _.[� � __., ....._._ e ¢.. �1 Dr...�,1; .. - �_.. � ��.-'_1�
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<br /> --_._. __. ..., __..._ _______ �' 7 Y�'.� ---
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<br /> Nature of USC oi Motor Vehicle: Are the moior Vehicles used
<br /> ❑AgriculturaVHorticultural n Educational g Religious �Charitable ❑Cemetery exclusively as indicated?
<br /> Glve delailetl description of use,including an explanation It multiple classi(ications exist: ,,,.�1 C.4� �/l� ��� �YES �NO
<br /> �� �+� - nY
<br /> �. ".��Y!'��.��`�`',r�_-..�-�C`[� C-l�WY YK�'(*'i�( If No,giv ta�� /,
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<br /> ��t�� 1 � 201
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<br /> Under penalties of law,I declare that I have examined this application and,to the best of my knowledge a d belieT,it i�pm��tl�ruf���f��
<br /> complete.I also declare that I a duly authorized tn sign this exemption application,and thst the organization own g said p��y3fb�5A�a�.N��P�s�
<br /> discriminate i bership or oyment 6ased on race,color,or national origin.
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<br /> SO�h ', _"'. �tJ� ��~ � \
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<br /> e�e rize Signature itle pate
<br /> __...- --,.. FQR C4 . .._. -----. , _.. . _....____ . _ -_�
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<br /> 11N7YTREASURER'S RECOMMENDATION
<br /> I�1JSS 7i.:..��'�.. .------
<br /> �PPROVAL COMM�NTS: __.
<br /> U�ISAPPROVAL . — ---..__.__.................... ..... _-
<br /> ,��l,r��� y��d-�'� �-°�� ��l
<br /> ► _ � _____ _ . --- ---_
<br /> �ature of County Treasurer Oate
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<br /> FDR COUNTY BOARD pF EqUALIZATION USE ONLY
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<br /> �APPROVAL COMMENTS: _..... .,..___.._
<br /> C]DISAPPR�VAL �� "
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<br /> Authorized Signature�' Qate i
<br /> Ncbraska Ue'--..... _...._.. _.__.,.-- �..—....�..,.-�.------- —..............._,--�
<br /> partment of Revenue Authorized by Ncb.f7ev.Stat.§77-202�1)(c)(d),§G03,1 q5§fiO3,189
<br /> 96-253��2006 V9ev.5-20U9 SUpersados 96-253-200G Rev.11-2D08
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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