Laserfiche WebLink
�•-►�� Application for Exemption �o�nn <br /> Nebraska Departrnani of <br /> REVENUE firom Motor VehicleTaxes by Qualifying Nonprofit Organizatians 457 <br /> •To be filed with your county treasurer. <br /> _ •Read instructipns on reverse side. <br /> ApplicanYs Name / Type of Ownsrship <br /> ���(�k� �y �;K �' � ,�C KOG( �Nonprofit <br /> Street or Other Mailing Address p County Corporation <br /> 3 � W• `!!f j"�°✓" � �"�^ o �A�/ ❑Other(specify)� <br /> ���, State Zip Code State Where Incorporated <br /> � <br /> (DENTIFY OFFICERS,DIREGTDRS,OR PAR7NERS OFTHE NONPROFIT QRGANIZATION <br /> Title Name,Address,City,State,Zip Gode <br /> �ci r�w 'r• •x/.3 M 3 <br /> M <br /> �K M� <br /> / <br /> p�SCRIPTION OF7HE MOTpRYEHICL�S <br /> �Attach an additional sheet,ff necessary. <br /> Registration bate or <br /> Motor Vehicle Make Model Year Body rype Vehicle ID Number -'�Date of Acquisition, <br /> 'rf New Purchased <br /> � oa � <br /> Exempt Uses of Motvr Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaUHorticultural �Educational �Religious ❑Charitable ❑Cemetery <br /> as indicated? <br /> Give detailed description of use,induding an explanation if multiple use dassitications exist: � <br /> �Kf'��IYI�t. �7`��� SG�Od� �"'�/'Z 9'7'dG14'f fNv�9ive rc 1��. <br /> r �raKx�o,�t s7`+�c�c��s/5��7`r, 5�.r�X-�cccr{-r`v+�+:� i <br /> � a�t��.;��� as �r� �EB 1 3� �Q12 <br /> �✓. f�wvf"`/Jus.f� �"� �Ai-LCOUrvTY <br /> TREASUR� � <br /> Under penalties of law,I declare that I have e�mined this application and that it is,to the best of my knowledge and beli �F�A..INEBRASKA <br /> also declare that I am duly authorized to sign this examption application,and that the organization owning the above-listad property dces not discnmina e <br /> in membership or employment based on race,color,or national origin. <br /> sign �,�,� �� � � _ � <br /> here � ��_' � tur � 7itie pate <br /> FOR COUNTYTREASURER RECQMMENDATION <br /> �PPROVAL <br /> COMMENTS: /�SS 7 7 � o�i drZ— <br /> ❑DISAPPROVAL <br /> v�°��.�.�e-. .�-�y�.�.s <br /> Signature o untyTreasurer Date <br /> FOH COUNTY BOARD QF EQUALIZATION USE ONLY <br /> �APPROVAL COMMEN75: <br /> ❑pISAPPROVAL - <br /> I <br /> rize ignature Date , <br /> Nebrsska Department of Re�erwe Authorized by Neh.pev.StaL§§77-202(1)(c)and(d),and 60-3,185,and 80-3,�89 <br /> 9s-253•20p6 pev.8-2017 Supersedes 9G253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOL1R RECOR►]S. <br />