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��� :� � � a:.. <br /> ��� Application for Exemption � FoRnn <br /> Na6raska Department of <br /> REVENUE from MotorVehicleTaxes by Dualifying N�nprofit Organizatians 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> ApplicanYs Name Type of Ownership <br /> ��l �' " `v'�-h�G�..3 f{.0. � i u d c�� �e. V-� � �A[.- �K Nonprofit <br /> Street ur Other Mailing Address Coun q Corporation <br /> ,,Z 5 3� �.c7ur''�-�4 n ���-• ����`1� �Other(spedfy): <br /> G�h, State rp Code . State Where Incarporaled <br /> �.�.�. I 1�-�.� N � � � s a 3 �l � <br /> IDEN7IFY OFFICERS,DIRECTORS,OR PAI�TNERS OF TH�NONPROFII"ORGANIZATION <br /> 7itle Name,Address,City,S�ate,Zip Code ' <br /> ��. I r M 0 S S r, n N� l� a ( <br /> v � r Ch i c� �' t� x l�4 G� bban NE 6 8Qu <br /> .Sr.c. � Tr eEt,S t.�r�e.r �r. e a �lo l K $F. dr� � 6 $8 � �. <br /> G E D Q �c�r��c a.m tl I b rv �nd�r Ha t�; � 6 $ 9 6 1 <br /> DESCRIPTION OF'I'HE MOTQH VEMICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> MotorVehicle Make MadelYear BodyType Vehicle I�Number Date of Acquisition, <br /> if Newl Purchased <br /> [y a Il t� FD��� FSI�13A � 6S6 ►- � 8 -/2 <br /> Exem t Uses of Motor Vehicle: Ara the motor vehiales used exclusively <br /> P Reli ious Chantable ❑Cemetery as indicated? <br /> �Agricultural/Horticultural ❑Educational ❑ 9 � <br /> Give detailed description of use,including an explanafion if mWtiple use classifications exist: [�YES []NO <br /> �d �"ra..,nsPor�` �Q.Uc.�o� 1'YI�R�¢l� Y � i5a.b`� IfNo,give���� <br /> J <br /> i v�� i u� d u�.�t.� 5 . <br /> JA N 2 6 2(�12 <br /> Under penalties of law,1 declare that I have examined this application and tliat it is,to the best of my knowledge and bel f,irue,corry�R_ FFiC� <br /> also declare That I am duty authorized to sign this axemption application,and that the organization nwning the ahov�list ro n 14�f1�cF�� EF3RA�IC,4 <br /> in membership or employment pased on race,color,or national origin. <br /> S�gh , �t"��. � �rrc.�6r � d.(a l 1.- <br /> here t nzed Signature 1 Title Date <br /> \ <br /> FOR COUNTYTREASURER RECOMMENDAl"ION <br /> [�-APPROVAL COMMEN7S: � f � <br /> [�DISAPPFiOVAI�. <br /> �� -�� /- a �-��._ <br /> . ' - <br /> r 5ignature oi Counry Treasurer pate <br /> FOR COUNTY BOARD dF EQUALIZATION USE ONLY <br /> �APf'ROVAL COMMENTS: <br /> (]DISAPPROVAL <br /> �/— G <br /> � thorize Signa u Daie <br /> Nebraska peperiment Of Aevanue AutMrizad try Neb.Fee 5lel.§§77-202(1)(c)and(d),and 60-3,185,and 6o-3,1 B9 <br /> 96-253-2006 Rev.8-2011 Supersedas 96-253•20D6 Rev.5-2009 <br /> PLEASE RETAIN A CQPY FORYOUR RECORDS. <br /> i • <br />