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��f� <br /> �nr�� Appiication �for Exemption FORM <br /> Nebraska Department ot <br /> REVENUE �rom Motor Vehicle Taxes by Glualifying Nonprofit Organizatians 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applic�nYS Name , Type of pwnership <br /> CENTER FOR INDEPENDENT LIVING ° �J Nonprotit <br /> Street or Dther Mailing Address County Corporation <br /> ��(��' � �,(7��� �� �'T HALL �pther(specity): <br /> Gity State Zip Code State Where Incvrporated <br /> GRAND ISLAND NE 688Q3 NE <br /> ID�NTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFI7 QRGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> u v <br /> , l ` � � lU� Co �' <br /> l.�r� n 1V�. �.PB'S��1' <br /> PESCRIPTION OF THE M4TOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> MotorVehtcle Make N�odelYear eodyType Vehicle Ip Number Date of Acquisitian, <br /> u���..,i..���.....�.-.,w <br /> 5' � N �r n'i 7.�0 <br /> i ' or -t� g i � �. <br /> D�r i�u�� �9y <br /> �xempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> �AgricuHural/HorticWtural �Educafional �Religious �Charitable �Cemetery as indicated? <br /> Give detailed description ot use,includin�an explanatlon if multiple use classifications exist: �YES �NO <br /> ��LMd.u�q s.�►u-��, �r1c�u�► �c� ��.�r.��' ��� /"i � ,;::� <br /> ��� �a .� �/ �L�LLJ L�I.C�-�/ L�/ � ���7 If Nv,9���V����� <br /> - u� �:� 7�.�n�:� �- ���ru.��r�, � ' <br /> � D E^ 2 1 2011 <br /> NA�_�.couNrv <br /> Under penalties of law,1 declare that I have examined this application and that it is,to the best of my knowledge and lief,true co tb�F,�a6�?�FIGE <br /> also declare that I am duly authorized tv sign this exemption application,and that the organization owning the above-li RA51CA <br /> in membership or employment based on race,color,or national origin. <br /> S I g n ''�,,�,�`.�-r�'��� �X'�'1.L�LC1�..�Ir'�P,CfQ7' �� <br /> here orized Signalure Title Date <br /> rGR CGiitvTY i ncA3liR�F flci,GiJ11�1EiJviaTiviv <br /> [�PPROVAL C�MMENTS: -���S ��s���- <br /> ❑D15APPROVAL <br /> ���_�aer�_� �� -��// <br /> Signature of Gounty 7reasurer Dete <br /> FQR GpUNTY BOARD OF EQUALIZATION USE ONLY �� <br /> APPROVAL COMMEN7S: __�._ <br /> [�DISAPPRpVAL <br /> /���� <br /> uthorized ignature Date <br /> Nebraska Department of Revanue Authorizad by NB6.Rev.Sfat.§§77-202(1)(C)and(d),and 60•3,785,and 60•3,769 <br /> gs-253-2006 Rev.8•2011 Supersedes 9Fi-253-2006 Rev.5-2oag <br /> PL.EASE RETAIN A COPY FOR YOUR RECORDS, <br />