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�..c� �� <br /> ,e�-- Application for Exemption FORM <br /> Ne6reska Departmant of <br /> REVENUE �rom Motor Vehicle Taxes by�ualifying Nonprofit Organizations 457 <br /> •To be filed with your caunty treasurer. <br /> •Read instructions on reverse side. <br /> AppiicanYs Name Type of Ownership <br /> YWCA�F GRAND (SI_AND �Nonprotit <br /> Sireet or Other Mailing Address County Corporation <br /> 211 E FONN�R PARK Rp HALL <br /> �Other(spOCify): <br /> City S�ate Zip Code State Where Inwrporated <br /> GRAND ISLAND NE 68801 NE <br /> IpENTIFY OFFtCERS,DIRECTORS,OR PARTNERS OFTHE NpNPROFIT ORGANIZATION <br /> Title Name,Address,City,5tate,Zip Code <br /> r� � �..._ �Y' <br /> u.r i r_ ov��-��c�cj �! i.J K6 E� b�� <br /> �. . ' �7c��r�� f�cc...� �.�1.� /� G' .Z 1� .� <br /> J <br /> pESCRIPTION OFTME MOT4R VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> '"'"— RegistratiUn vai�ar <br /> Motor Vehicle Meke Model Year I BodyType Vehiele ID Number Date of Acquisition, <br /> if Newly Purchased <br /> ��r v iF' 2/H 3 <br /> � � �..._ ��,� r-' � �NB ss9 <br /> C'W r�' �9 9 G ie� �n ' <br /> Exempt Uses of Mntor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural �Educational �Religious �haritable ❑Cemetery as indicated? <br /> r� <br /> Give detailed descriptipn of us�,including an expianation if mulTiple use classifications exist: �YES �NO <br /> �T <br /> %�/7.:��i'��'Ur� v�r �/•�o.�f /�rrl� C��j�l i'e.l' � <br /> .��� �������.� -�� y��� � EI <br /> p�� �. 201� <br /> Under penalties of law,I declare ihat I have examined ihis application and that it is,to Ihe best of my knowledge and beii f,true,complete, o �.ry <br /> also declare that I am duly authorizad to sign this exernption application,and that the organization owning the above-liste property doe�s p��1GE <br /> in membership or employment based on race,color,or national origin. Gf3AMp ISLAND,NEBRASKA <br /> Slg � �i/�7 �:� ����/ <br /> her Authorized Signature Title Date <br /> _�. <br /> FOR COUNTYTREASURER RECDMMENUATION I <br /> �PPROVAL COMM�NTS: �./ �� I <br /> ❑DI5APPROVAL <br /> ia ay�i� <br /> Signature of County Treasurer Date <br /> FQR COUN7Y 60ARD OF EGIUALIZATION U5E ONLY <br /> APPROVAL COMMENTS: — , <br /> �]p15APPROVAL <br /> / ��� <br /> Authorized ignature Date <br /> _ <br /> Nebraska Department ot Ilevenue Authorized by Ne6.Rev.51eL§§77-202(1)(c)and(d),and 60-3,185,end 603,189 <br /> 96-253•2006 Rev.B-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECpRDS. <br />