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, ,�� �a � � <br /> � ��� � �� <br /> 3 <br /> "f0 BE FILEDWITH Application for Exemption � 'I FORM <br /> from Mo#arVehicleTaxes <br /> YOUR COUNTY by Qualifying Nonprofit prganizations 457 <br /> TI�EASURER •Read instructions on reverse side <br /> �—.�,�. _. <br /> Ap IicanYs Name County Type of pwnership <br /> . W��,� .��.�� _ ....��—._... �Nonprofit <br /> Street or Other Mailing Address Counry Number Corporation <br /> �__r.+0`�..� ., �� ��-_.1� _ �. ❑Other(specify): <br /> 1-� <br /> ��� State Zip Code State Where Incorporated <br /> ��1 ��.� . ►��. _..���.. .. ��_... -:. �- <br /> Identify Officars,Directors,or Partners �•� <br /> �. _. ... _...,. . . . <br /> Title Name,Address,City,State,zip Code � _ ._ „ _,,, <br /> _, _ <br /> � ... _,.. � <br /> ---. _, <br /> _. �IST Sf'� � _. . ...� <br /> _. _ __ ._. <br /> CIFIC DESGRIPTION OFTHE MOTOR VEHICLES <br /> C •Attach additional sheet if necessary J <br /> _ . ._ . ,. _ <br /> - Registration Date or Date <br /> Vehicle Make Model Year Body Type Vehicle Identification Number of Acquisition if Newly <br /> Purchased _ <br /> � ��_. .��. .�C�L�.. ���X—�i"l.��.._... �.,.�`� <br /> A riculturaVHorticultural Educalional Reli ious Charitable ❑Ca f <br /> Nature of Use of Motvr Vehicle: Are the motor vehicles used <br /> � � g � metery exclusively as indicated? <br /> ❑ 9 <br /> Give delailed description ot use,including an explanation if multiple classifications exisL __ � _ YES ❑NO <br /> • If No,give�� �� <br /> �`--_ _ _, _.. <br /> . _ _ At1G 2 9 20Zi <br /> --_ __. .. Mnc_t.cnurrrv <br /> � Under penalties of law,I declare that I have examined this application and,to the best of my knowledge a d delief,' ' S'r$i��' ,� ��$�,�5� ' <br /> complete.I elsn declare that 1 am duly authorized to sign this exemption application,end that the organization own <br /> discriminaCe in membership or employment based on race,color,or natipnal origin. <br /> sign - �. 4- ����/ <br /> here �Authorized ignature Title Date <br /> . . <br /> _. r _. � <br /> � - DATtON <br /> FOR COUNTYTREASl1RER�5 FiECOMMEN <br /> COMMENTS� v '� , ,/LJ.�J /y –r�a� _ .....,— <br /> �APPROVAL �-- �- <br /> []DISAPPROVAL —._... � --- _ -. .. <br /> � g'-��i -j � <br /> Signature of Counry Treasurer pate y <br /> � FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> f�APPFiQVAL COMMENTS: _ _ ...,_ —_..... —... <br /> �DISAPPROVAL __ _- - - . _... ____.. <br /> _..... ��. • `/I <br /> uthorized Signature pate <br /> Ne6raskfl Department o�Revanue � Authorized by Neb.Rov.Stflt.§77-202(7)(c)(d),§6D3,185§fi0-3,789 <br /> 96-253-2006 Rmv.5-2009 Supersedas 96-253-2006 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUFi RECORDS <br />