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<br /> Application for Exemption � � � Fo�M
<br /> TO BE FILED WI7H from Motor VehicieTaxes 457
<br /> YOUR COUNTY by Qualifying Nonprofit Organizations
<br /> 7REASURER •Read instructions on reverse side _...—_...—.. ----------—
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<br /> County Type af Owncrship
<br /> Applicant s Name /^
<br /> � l ' � ' �.If7�'e ,4c, l�l'G' 1� !'�� ���G �Nonprotit
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<br /> Sire or Other Mailing Address
<br /> _ /� �Other(sper,ify).
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<br /> _�_�_��,�_..���'h��'°=" �' - Zip Code State Where Uicorporated
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<br /> Nume Address City,State,Zip Gode _ �_.— , — /
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<br /> - -- —� CIFIC DESCRIP710N OF THE MOTdR VEHICLES J
<br /> •Attach additional sheet if necessary ___...___..___—.
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<br /> - --- - ---- Regi tr�tlon Uate or�ate
<br /> ---—°---- -----"— of Ac uisition if Newl
<br /> ModelYear dy7ype Vehic:le Identifir,ation Number 9 y
<br /> vehicle Make ��
<br /> I'urcha ed
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<br /> _,—_.—-- -- Are the mntor vehicles used
<br /> Nature of Use of Moior Vehicie: exclusively as indicated?
<br /> ❑Agricultural/Hurticultural �Fducational �'Religious �Charitable �Cemetery
<br /> ��$ �NO
<br /> Give detaited description of use,including an explanation if multiple classifications c�xist:
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<br /> Under penalties of laW,�deolare that i have examined this application and,to the best of my knowiedge an belief,it is corre�t and i �,
<br /> complete.I also_declare that i am� duly authorized to sign this exemption application,and that the nrganization owni said prope�ty doks a�at r .�1 � �
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<br /> discrimin.ate in membership favemployment based on race,color,or national origin. �� Y � �,,
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<br /> — — Date
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<br /> here _A��t�,or,�����n�ture _ — _— ---
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<br /> _. — —_ .— .— _—.
<br /> — — FOR COUNTYTREASURER'S RECOMMENDATI
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<br /> COMMENTS: _ � ,� _.,._ . , _':—_`:_—. —_._— _—. _— -
<br /> ��F�I'PROVAL -- ` .— - —
<br /> ❑D15AI'PROVAL ----.--- --.—_.--...-- —..—. —..
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<br /> Signalure of County Treasurer �ate
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<br /> FOR COUN7Y BOARD OF EQUALIZATIO
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<br /> COMMCNTS: --..�._ -.—..._—... —_.,—...—_..--.—
<br /> �]APPNOVAL � •
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<br /> [J DISAPPF�OVAL T �
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<br /> �r .�,���,��`����i� oa"���/�l
<br /> '1�uthor¢ed Signature
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<br /> � �� Au[hori�ed by Nel�.Ficv.Stat.§7J-202(1)(c)(d),§60-3,185§60-3,189
<br /> Nebraska Deparlment o(Revenue �
<br /> 96•253-200E Rav.5-2oDS Supersedes ss-25s-zDO6�ev.��-2DO�3 NLEASE MAKE A COPY FOR YOUI�RECORDS
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