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�.�� �- <br /> ��f Application for Exemption Fo�M <br /> Ne4�aske Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 45,7 <br /> •To be filed with your county treasurer. <br /> •Read instructipns on reverse side. <br /> ApplicanYs Name Type of Ownership <br /> DRPHAN GRAIN TRAIN �Nonprofit <br /> Streef or Other Mailing Address � County Corporation <br /> 427 N SHADY BEND RD- GRAND ISLANb MAIL 7O PO BOX 1565 HALL [�pther(speciTy): <br /> City State Zip Code State Where Incorporated <br /> MASTINGS NE 68902 N� <br /> IDENTIFY O�FICERS,DIRECTORS,OR PARTNERS OFTHE NpNPROFIT ORGANITATION <br /> 7itle Name,Address,Giry,State,Zip Code <br /> f� �fN A- `t46 �t2, C��-,e � �v t r c. , ��s ' Si R-��c o�t ��r�- �f��oa� .� �fi'r' ( <br /> �1`�12 L' r�` �L`� /� , <br /> a�r�- e. c.-ri-, r U. �r ( F �� .�c� <br /> � � � �'�� <br /> _� � ,-,L � +s r _ 5 [p� ' b� <br /> , <br /> DESCRIPTIq�OF THE MOTOR V�HICLES <br /> •Attach an additional sheet,if necessary. <br /> Registratian Date or <br /> Motor Vehicle Make Madel Year 8ody Type Vehicle ID Number Date of Acquisition, <br /> � . if Newly Purchased <br /> r- _ry�� c�c� , � ` v F�S� : �•✓" f�3�_� .� •� id <br /> 2 � ��� � t� �'� r ��4/+8- �� � �f <br /> ��� �r'dai,C f�� a � '� '� -�" 6/ cRac .Z.3� � - G/( <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusiveiy <br /> �Agricullural/Horticultural ❑Educational ❑Religious �Charitable ❑Gemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exisf: �YES �NO <br /> (��S�D �o/� ���� �',����; N� /-����v:�G� t..s e�,s�, ('����� <br /> C� If No,give percentage of exempt use: <br /> �.,C�D �p L�-ac_�c[�� c�?- �e�+-="'`�-C� �"r <br /> n r � � ��� �i �r <br /> f7'ti�Y .�J�c�C�" ������� � FlJ CG NS�� �L�E��4D <br /> � <br /> �[U�T�<!� G'�r2y � � r-_cK �G�—�j�d �c� �� �1�G — <br /> Under penalties of law,I declare that I have examined this application and ihat it is,to the best of my knowledge an belief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above sted property does not disnriminate <br /> in membership or employment based on race,color,or national origin. HA'_(.CAUIV'fY <br /> Tf2�q5l1RE.RS dFFiC� <br /> GRf�FdC:J I'.�[.6\fJt7.N�$h'AKSA <br /> sign - �� �:.�.-� .�� r ._a _ <br /> h��e uthorized Signatur Title Date <br /> FOR COUNTYTR�t1SURER RECOMMENDATION <br /> �APPROVAI. COMMENTS: �� �`' �'�`''�' <br /> ❑DISAPPROVAL <br /> , U ��.1 _����-�y'// <br /> Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUAl.IZATION U5E ONLY <br /> APPROVAL COMMENTS: _, <br /> ❑OISAPPROVAL <br /> � - 1�-%�— <br /> authorized Signature Date <br /> Nebraska Departrnenl of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 6D-3,7B5,and 60•3,189 <br /> 96-253-2006 Rav.8-201�Supersades 96•253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY�OR YOUR RECORDS. <br />