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'�� Application for Exemption �o�M <br /> N�ska�ep�artnl�ent of <br /> �'tE�GN�1C from Motor Vehicle Taxes by�ualifying Nonprofii drganizations n�� <br /> VG •7o be fiied with your cnunty treasurer, �,t <br /> •Read instructions on reverse side. <br /> ApplicanYs Name Type of pwnership <br /> CJ���.5 Cti�T e.�i f!� L•C''�T'r�1 !V{� I�Q Nonprotit <br /> Street nr Other Mailing Address County T"Gorporation <br /> �4 W �`'��� ��� ❑Othcar(specify): <br /> City Slate Zip Code State Where Incorporated <br /> �= /vE �s��� N C <br /> IDEN7IFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPRDFIT ORGANIZA710N <br /> Title Name,Address,City,State,Zip Code <br /> �(p �d�� l► 'z.a,�.a. 2vV g sl- S►v1�1o•. AJE Gd47b <br /> ;� �esic�r► v d rtwS Za S . ��eUa�. Al� la887b , <br /> �e,, 5 W i7.o3 Ctd� � C+. � l�.-1� GT A/E GF&b3 � <br /> eds. �r�. sa� 3ro7 ��re S GS ,u �' '' <br /> �ESCRIPTIDN DFTHE MOTpR VEHICLES <br /> •Attac.h an additinnal sheet,if necessary. <br /> Registration pate or <br /> Motor Vehicle Make Model Year Body Type Vehicle I�Number Date of Acquisition, <br /> if Newly Purchased <br /> GTro�:le,rs �Z. 1x14T 5 E ►bZ2WGM51145'� 1/Z7 � <br /> Exempt Uses of Motor Vehicle: Are the mntor vehicles used exclusivgly <br /> �Agricultural/Horticultural �Educational ❑Religiaus �Charitable �Gemetery �s indic�at'��r <br /> ))),,,......��� 1 <br /> Give detailed description of use,Including an explanation if multiple use classiticatiqns exist: �y�YES �Nb <br /> re G- rwr� rc�i� Seru i t�. or�c..w�"2a}9o,.�- t,.•� Pr�DV i c �� w�`;c, <br /> r�•� <br /> W� d` P � P If No,give percentage of exempt use: <br /> �,�� �-o C�1Sa��+•� i'+d�U1c�.lA�•T��-er 1✓��� b{ .,s�d i� �\ br�,S � <br /> �, �k.� �;'t�-(Y.�s • <br /> lJnder penalties af law,I d�clare that I have examined this application and that it is,to the best nf my knowledge and belief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this expmption application,and that thg organization owning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign � �,� �� -�� z/z3 /zd,z <br /> here �Authqrized Si ture Title Date <br /> FOR COUNTYTR�ASURER RECOMMENI]ATIpN <br /> [�APPR�VAL. COMMENTS: �, ��"� � ?'�� '��°Z" ---— <br /> []pISAF'F'ROVAL <br /> \ � � �� ����'�, <br /> - --- <br /> Sig�o Co nty TrOasurer Date <br /> FOR COUN7Y BDARD OF EQUALIZATION USE DNLY <br /> �APPROVAL GOMM�N7S: <br /> ❑ <br /> 171SAPPR�VAL <br /> � <br /> uthorize Signature � ie i <br /> Nehraska Ctepartment of Revenue /+utnorized by Neb.Rev.Stat,§§7�-202fi)(r.)and(d),and so-3,td5,ano ao-3,78s <br /> 96-?.53-2008 Fev.B-?.p11 Supersedes 96-253-20D6 Rev.5-20U9 <br /> pLEASE RETAIN A COPY FOR YOUR RECORDS. <br />