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.�� • � ��� �� t� l �� <br /> , �,u t �--� <br /> Apptication for Exemption �� �oRnn <br /> TO BE FILEDWITH from MotorVehicleTaxes �— ��� <br /> vouR coUN'rY by(lualifying Nonprofit Organizatians <br /> TR�ASUHER 'Read instructions on reverse side <br /> Caunty Type of Ownership <br /> Ap IicanYs Name , <br /> �Nanprafit <br /> County Number Corporation <br /> Street or Other Ma�ing Ad ress <br /> ` � []Other(speciry): <br /> �/ State ip Code State Where I�rporated <br /> ��ry� � � <br /> Identify Officers,Direetors,or Partners <br /> T�� Name,Address,Ciry,State,Zip Code <br /> L,ISI'SPECIFIC DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach additional sheet'rf necessary <br /> Registration�ate or Date <br /> Vehicle Make <br /> Model Year Body Type Vehicle IdentificaGon Number o�fu��tlo�rf Newly <br /> MOV(I� <br /> a m io <br /> Are the motor vehicles used <br /> Nature of Use ot Motor Vehicle: ezclusively as indicated7 <br /> �AgriculturaVhWrticu�tural <br /> ��ducationai ❑Religious ❑CharicatNe ❑Cemetery <br /> �YES ❑NO <br /> Gi�detailed description of use,including an e la��f muttlple classifications e�t: - � M1 ; R <br /> �.1(1 L � ` ���:: , �,. <br /> � If No,grv� ` � � <br /> . � W < < I <br /> n� <br /> FEB -I4� " <br /> ����7 <br /> r�;:,�.: � , �,r;•��- <br /> lication and,to the best of my knowled9e d be� �r!s,�°!�`� � -��-��:•�SA <br /> Under penalties of taw,�de�la►E that I have examined this aPP ���ation,and that the organization �=- ��`•^ <br /> comptete.I alsa declare that 1 am duty sukhor o sign this exemption app � <br /> discrimiaa� bership or employmen�L�sa on ra f color,or nationai origin. <br /> ! � ` - '/�` <br /> / �~. �trc�`� O� <br /> s��n Date <br /> here � T`t� <br /> Author¢ed nature <br /> FOR COUN EASURER'S RECQMM�.N�AT10N <br /> S �7 � -- a.o� <br /> �PROVAL COMMENTS: <br /> �p15APPROVAL <br /> � --�v -1,� <br /> Signature of County 7rea5urer <br /> Date <br /> FOR COl1NTY BOARD OF EGlUALIZAT1pN USE ONLY <br /> IYI APPRQVAI. COMMENTS: <br /> r <br /> ��ISAPPROVAL <br /> ..�y^'�c�-�- <br /> horized Sig a <br /> ate <br /> Authorized by Neb.Rev.Stat.§77•202(1)(c)(d),§60-3,165§60•3,189 <br /> Nebreska Department ot Revenue <br /> gg.p53-ppp6 Rev.5-2009 SupersBdes 96-253-2006 Rev.1�'z�08 pL�ASE MAK�A COPY FOR YOUR REGORDS <br />