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<br /> �+��- Application for Exemption �o�M
<br /> Ne6raska�eparCment oF
<br /> REVENUE from Motor Vehicle 7axes by Dualifying Nonprofit Organizations 457
<br /> •To be filed with your county treasurer.
<br /> •Read instructions on reverse side.
<br /> ApplicanYs Name Type of Dwnership
<br /> CRISIS CENTER INC
<br /> �Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 2251 N WEBB RD PO BOX 5885 HALL �Dther(5peCify):
<br /> City Slate Zip Code State Where Incorporated
<br /> GRAND ISL.AND NE 68802 NE
<br /> IDENTIFY OFFICERS,DIREC7QRS,OR PARTNER5 OFTHE NONPROFIT ORGANIZATION
<br /> Title Name,Address,Gity,State,Zip Code
<br /> cL �r �1', c�»��a,�nc �l��l w�ty� 'rr: ci;. � am NC lp �,p�
<br /> �
<br /> 'U a.�r�v'� Cho.�< ',Sl�no..,-d y-� u - C:c 'I ur„ ry � .,���
<br /> �.- -�„r 4:d�(�� �i a w K��,.,', G�w,,d 'T 10.n�1 N c t���c
<br /> �C z,.XCIT;�e,ctn wc Ca.��;1 V�1',1\a.r a YYl wn -r:a- � . --� 'I \W+�, N E. `+��v=,
<br /> DESCRIPTION OFTH�MOTOR VEHICL.ES
<br /> •Attach an additional sheet,if necessary.
<br /> Registration Date or
<br /> Motqr Vehicle Make Model Year Body7ype Vehicle ID Number Date of Acquisition,
<br /> if Newly Purchased
<br /> �-a " �o' e�,� w 1 G 0" 6 " �i o
<br /> d �. I��z �� vr� �8y Hs:� ;ro��►4�}�
<br /> � �1 3 D�.�: � i C��.GO a3 � �'��3�t3 s i
<br /> o, �e::i ��o-� Pae.c �io�1 aoc 1 lr, .�c tv�.
<br /> I� -u+�..F I�tq$ ��::�.� I� ° iolXwC.2�il�'
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricultural/Worticultural �Educational �Religious �Charitable ❑Cemetery as indicated?
<br /> Give detailed description oi use,including an explanation if multiple use classifications exist: �Y�S �NO
<br /> 1�.harru.rnu_[�-'�rv��ler�is�ASu� �s ot�loc�in �c�.t�.l l�z.r�w►n-I; r,� trc,�.�r-
<br /> �I`��1.5��`'t'c�'`Ctc.ars.s�nC`C �^ e1'�Y'nw�-l.r��5 am� S�'!n�[w.�Y�}oa LU�` " �Y�-0.. , Yw
<br /> �
<br /> V e�,c�w ar.�,�s�.� fi�t`�•�,s�a�t CI'�,.nt� �c� -1-�n i,� C�;,` rti�n.��,
<br /> �� a.1S� ��. �a e,��� ,� do��-r�,o;�, Nov 2 s 20t1
<br /> Under penalties of law,I declare that 1 heve examined this application and that it is,to the best vf my knowledge and beli f,true,complete,��o�q§��-ry
<br /> also declare that I am duly authbrized to sign this exemptipn application,and that ihe organization owning the above•liste property doeR�pi�aiq�pp�ry��
<br /> in membership or employment based on race,color,or national origin. GRANO 1"!,,��:U,NEBRASICA
<br /> sign � ��-� �h{_G���.+ !^Jt�[-C��r ,, I�1 11
<br /> here Authorized Signature Title Date
<br /> FOR COUNTYTREASUR�R R�COMMENDATION
<br /> �APPROVAL COMMENTS: ��1.�5�----����'Q°Z'
<br /> ❑DISAPPROVAL
<br /> ► .C��1.t.�l��d� �� --Z 1�!/
<br /> �ature of County Treasurer Date
<br /> FqR COUN7Y BOARD OF EQUALIZATIDN U5E ONLY
<br /> �PRDVAL COMMEN75:
<br /> ❑D15APPROVAL �._
<br /> �� `��
<br /> Authorized ign Date
<br /> Nebreska Department of qavenue Authorized by Neb.Rev.51at.§§77-202(1)(c)and(d),and 60-3,185,and 603,18g
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5•2009
<br /> PLEASE RETAIN A CdPY FOR YOUR RECORDS.
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