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<br /> TO B�FILEDWI7M Application for Exemption FORM
<br /> from MotorVehicleTaxes
<br /> YpU�t coUNTY by Qualifying Nonprofit Organizations 4,57
<br /> 7REASUFi�F1 •Read instructions on reverse side
<br /> _„_ . �._.. _�... _ ,__ ------ - --... . --
<br /> A IicanYs Name ? � Caunty Type of Ownership
<br /> .�` ,.��',�S—Tl�,C-+-.� ��C __ � Nonprofit
<br /> Street o`r O"thCer Mailing Address ` Gounty Number �orporation
<br /> .S C.LIL.4. ��' �' v ' ` _� "� \�10� __..._..�_ n Other(specifyj:
<br /> Cit State Zip Code State Where Incorporated
<br /> �c�d _.���.��. .._. ._ l.p �`�a a. �.... -. ._
<br /> Idontify Officers,Directors,or Partners
<br /> ___,....— _ --...._._. __.._.... . .----
<br /> Title Name,Address,City,Statc,Zip Code
<br /> _.. _
<br /> —.... ..... --- .__._. _._,..
<br /> �•^��-_ -- _ __.. __. ....,_ _._......_—
<br /> �� � . LIST SPECIFIC DESCRIPT ~J _ -- t r Da f-
<br /> __._ _.
<br /> 1"ION OFTHE MOTOR VEHICLES
<br /> •Attach additional sheet if necessary
<br /> ... .. _ _....- --__ _.._.,...... Re istratio.n ,..._..
<br /> g Pa e o te
<br /> Vehicle Make Model Year Body Type Vehicla Identifir.ation Num6er of Acquisition if Newly
<br /> PufChased
<br /> �._._. _.......�. .. ....
<br /> ..._ .._..,,. .__
<br /> .._ _.. ..., ..,. . . .
<br /> ____��,���_..... v��_ .. ����t�--- ►� .�� t�R� �a q�� _....t�►�e�rrti. -�}`'1
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<br /> .. __ _
<br /> --- -._._. .
<br /> - -�P< 1�,..
<br /> m _. _. ----......... _. ._..- ..._ ...--
<br /> Nature of Use of Motor Vehicle: Are the motor vehicles used
<br /> .,-�( exclusively as indicated?
<br /> U Agricultural/Horticultural TiGL�ducatinnal ❑Religious ❑Charitable ❑Cemetery
<br /> �_�
<br /> Give detailed description of use,including an explanation ii multiple classifications exist� __„_,,_ _ �YES ❑NO
<br /> ��� � � _, ��a�� :...� 1�-,�,r,,,,p �l��a�5—
<br /> �c�]��c-t n� � l���'+.J �t t�5 ra r� G'��r..�. � ��
<br /> �.._.._ .�. _ __ _.�_...--- — - �1ii " � LU�i
<br /> � Under penalties of law,I decNare that 1 have examinad this application and,to the best of my kno ledge and belief it is correct and
<br /> complete.l also declare that I am duly authorized to sign this exemption application,and that the organiza on owning,cpi..r�}�r��5���r,�
<br /> discriminate in memqership or employment based on race,color,or national origin, TFrr�SURr
<br /> GRANR ISLAIVC?,NEfl1��.KSA
<br /> S19n ` ' �F' O 10.- 5- 1\
<br /> here �horize ignature Title Uate
<br /> _ __
<br /> ___.._._.__. _..__ --
<br /> FOR COUNTYTREASLIRER'S RECOMMENDATIdN
<br /> ., .� _..,..-- --....,__ _,.....--- —.. ....._.___ _._._.
<br /> �APPROVAL COMMENTS: S ��'— °��°� _.,....� ...
<br /> �DISAPPROVAL �... . ._.._. ---.,_
<br /> `t�-S'-I/
<br /> _..,�.� ._._ �._....
<br /> Signature of Counry Treasurer Date
<br /> ..___. _ .. - - ..._-- ---............. __..._... �
<br /> �T FOR CQUNTY BOARD OF EQUALIZATION USE ONLY
<br /> �APPROVAL GQMMENTS: _...___. _.T ___-.
<br /> �DISAPPRQVAL _, �._...,,. ....._,..
<br /> I�' 1�
<br /> ulhorized Signat J � pate
<br /> �.. _ w. _.,. �____.._.,, _.., - -...—
<br /> NebraskH�epartmant ol Revenun Authorized 6y Neb.Rev.Stat.§77-202(1)(c)(d),§60-3,185§60-3,19�J
<br /> 96-253-2D06 Rgv.5-2009 Supersedes 96-253•2006 Rev.11-2008
<br /> PL�ASE MAKE A COPY FQR YQIJR RECORbS
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