Laserfiche WebLink
�+��� Application for Exemption �o�M <br /> Ne6raska Depnrtment of <br /> �EVrENUE frpm Motor Vehicle Taxes by C]ualifying Nonprofit Organizations 457 <br /> •To be filed with ynur county treasurer. <br /> •Read instruction5 on reverse side. <br /> icant's ame �- 7ype of pwnership <br /> �'1 1 �JL.1 ���Q�It.� ��t m a � � �oG� ��- i Ionprofit <br /> Street or Other Mailin Address O� � County Corporation <br /> � � � ��r� Q I �Other(specify): <br /> Cit 1 State Zi Code Sta1e Where Incorporatod <br /> Q �� 1�1 a� �-�C� ��i � � <br /> IDENTIFY OFFICER5,DIR�CTOFiS;pR PApTNER5 OFTHE NONPRaFIT ORGANIXATION <br /> T N e,Address,City,State,Zip Code <br /> r� �'Q �� e o a anc .� a / <br /> � GtSr�r�� o r � u � - J <br /> h I N- ► r n <br /> e, '� ' d +� " (� r n �1 <br /> DESCRIPTI�N OF THE MOTpR VEHICI.ES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BDdy Type Vehicle ID Number Date of Acquisition, <br /> if Newiy Purchased <br /> b Q r <br /> " l � C� <br /> D � <br /> Exempt Uses af Motor Vehicle: Are the motar vehicles used exclusively <br /> �Agricultural/Horticultural �Educational ❑Religivus �Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation Ii multiple use classifications exist: �S [�NO <br /> �h i r�c�.� CUn�-r� I �-�h nr'�'�y �(5�S `�"'�?5� ��.�i C��5 <br /> C� 1 L1 Zl r� Q Vl � YY1 CL�S �f No,give percentaye ot exempt use: <br /> -�i�r -�-r��,s p d r�� h� I ns+, s-t,� �, � d <br /> a� �I �n��rc �� G�+y o�Grane( �'�lan�l a �� , l��el� <br /> ��.I � C�k h-�y o+.-n��rr�a l5 a-� I occ�l, �a�e a.�o� �c��r <br /> Llnder penalti�s oi law,I declare that I have examined this application and that it is.to the best of my knowledge and belief,true.complete,and correct.I <br /> also d�clare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership pr employment based on race,color,vr national origin. <br /> sig .��h-�.�v ' � _� . <br /> he ____- _ � � <br /> thorized Signature Title Date <br /> F4R CpUNTY7REASUFiER RECOMM�NDATION <br /> �APPROVAL CbMMEN7S: y'�� 7�r ���' <br /> ❑DISAPPROVAL <br /> �� �is�� <br /> Signature of ountyTreasurer Date <br /> FOR CQUNTY eOARti DF E(IUALIZATION USE pNLY <br /> �APPRDVAL COMMENTS: <br /> �DISAPPROVAL <br /> uihorized Signature Date <br /> Ne6raska 17eparlme7nt of Hevenue AulhoriZed by Ne6.Rev.5taL§§77•202(7)(C)anq(d),and 60•3.185,9nd 60-3,189 <br /> 96-293-2006 Rev.8-20�t Supersades 96-253-2006 Fev.5-2DD9 <br /> , P�,�ASE RETAIN q CQPY FDR YOLJR RECpRDS. <br />