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�� <br /> � , � � �� <br /> � ��� �''�`� � �� ���� Application for Exemption �oRM <br /> Nebraska bepartment of <br /> ►��NUE from Motor Vehicle Taxes by(�ualifying Nonprofit Organizations 45„7 <br /> •To he filed with your county treasurer, <br /> �Read instructions on reverse side. <br /> Applicant's Name 7ype of Ownership <br /> NEBRASKA STATE FAIR BOARD [�Nonprotit <br /> Street or Other Mailing Address County Gorporation <br /> PQ BOX 1387 HALL �pther(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,bIRECTORS,OR PARTNERS OFTHE NDNPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Cvde <br /> � � <br /> DESCRIPTION OF7HE MOTOR VEHICL�S <br /> •Attach an additional sheet,if necessary. <br /> Registration Date vr <br /> Mntor Vehicle iNake P�odef Year Boay Type Vehicle ID Number uate af qcquisition, <br /> i}Newty purchased <br /> + � a�� z� Fs � <br /> - Z- D Z�' z i <br /> �• zvv 1� - 5' 8 <br /> ` --- 2� � 3 <br /> Exem t Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> �A ricultural/Horticultural Educational Reli ious as indicated7 <br /> 9 ❑ ❑ 9' ❑Charitable ❑Gemetery <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: (�YES ❑N� <br /> T <br /> ' `'1e� eam�o.-ny V�:c.les D�-rc_ 1A,5ed by `n/�e... IS(,.►��-a51[� �'Gi1'�- �"i��r I No.9ivepe�R�� TI���f�D <br /> Br+a.-v'.� d�n� sfd�f -�r c�rv�pan� 415�.��ly . �� V Y G <br /> NQV 3 0 2011 <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and belie true,com 16�2�C�pg QF�ryC� <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed Ti8t0i�tifriyr�e ry�gRp�SKe, <br /> in membership or employment based on race,cvlvr,or national origin. <br /> sign -P � � � ��-��--// <br /> here Auth rized S' n ture � Title Date <br /> —_ . _._ _ �ATfON I <br /> FOR COUNTY 7REA5URER RECOMM�N __ _ <br /> [y�APPROVAL COMMENTS: ���� <br /> ❑DISAPPROVAL <br /> i�y:-�� <br /> ,Signature of Cvunty Treasurer Date <br /> FOR CpUNTY BOARp OF E�UALI�ATION U5E ONLY <br /> �PPROVAL COMMENTS: <br /> �DISAF'PROVAL n , <br /> f�l� <br /> Authorized Signatu Date <br /> Nebraska Depsrtment of Revenue Authonzsd by Neb.Rev.Stgt.§§77•202(1)(c)end(tl),and 60-3,185,and 60-3,189 <br /> 96-253-2008 Rev.8-2011 Supersedes 96-253-20p6 Rev.5•2D09 <br /> PLEA$�RETAIN A CQPX FOR VpUR RECORDS. <br />