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��-�--- Application �or Exemption FORM <br /> Ne6raska DepaRmeni c�f �. <br /> RGYGNVE from Motor VehicleTaxes by Clualifying Nonprofit Organizations �57 <br /> •To be filed w�th your county treasurar. <br /> •flead instructinns on reverse sida. <br /> f, nt5 N� e , /� . 7ype ot Ownership <br /> � ` u � ! �� (Jl � /�� L( � � � donprofit <br /> 5 r et nr ther Mailing Addres • County Corporation <br /> / [,�.{� '� � `��--�I � � I ❑Other(speciiY); <br /> � State State Whe,�f Irn�rporated <br /> t`C.�a'1 C` S � C'l h [�'� � � � V� <br /> IDENTIFY OFFICERS,DIRECTORS,OFI PARTNERS OFTME NONPROFI7 ORGANWITIQN I <br /> '�- ,Address City,State,Z�i Code ' <br /> rj � s �E� 1� Gi� L°Ct �I <br /> r-ec� . 1 e r � t.cs --�ra >t z a�� <br /> y �� � o r, � <br /> � e C �r. r.z r� a �- �%v- !� � <br /> DESCFtIPTION OFTHE MOTpR YEHICLES �I <br /> •Attach an additional sheet,if necessery. <br /> RegfatraNnn D�te w <br /> Motpw Vehide tiAake Mnde�Year BodyType Vehide ID Number Date oi Acquisitian, i <br /> it Purchased i <br /> o L� � ra r d/ r�~`' �a �' <br /> I <br /> E�rry�t llses of Motar Vetiide: Are the rrrolor vehides used exdusiv�aly <br /> ❑�g�,�ur�r��in,�� ❑�a��t�i ❑R���s ��mr�e ❑ce��ery es��a�c�rr I <br /> Give detailed dassr�tion of use,including an explanatlon'rf muttiple use dassificaiiais exist: �ES �Nq <br /> rc�?r-�.+LIC� <br /> I7ti �a�l �� �,�� 'e�m����'j'��`1�(� ��S��5� Ii No,givs percentage of exempt use: <br /> V ✓ / <br /> G-� Gt i 'D VY��l'Z� �01` 1`1'►C� n � l`�'►a�� a � h a�w r c�� � <br /> ���5�� r' -�ta i'� Q-�� � vr oL� ���`�e. �y1 C� Y� �eC�'S <br /> Under penal6e5 oF Iaw,l declare lhat 1 have examined this applicaeon and that it is,to ltre best of my krrov+ledge and belist,true,c�mplete,and correct,l <br /> also deciare tf�t i am duly autharized to sign this exemption aAq►icetion,and that the aganizaeon awning the above-listed proparty daes not discriminate <br /> in mem ip or errployrr�nt based on ra�ce,color,or national ori9in• <br /> sign- , ��� �� <br /> he� 5;���� .�,� . . �� <br /> FOR COUN7YTREASUREii RECOIIAMENDATIQN <br /> ❑APPRQVAL COMME�r ��� ��r°�Q� <br /> [,]p15APPRf7VAL <br /> � <br /> Signa of unty Treasurer Date <br /> FOR COUNTY BbARD OF EQUALRA710N USE ONLY <br /> C]APPROVAL COMMENTS: <br /> ❑piSAPPR�VAL <br /> � -��� <br /> 5ignature p xe <br /> N9breska Depertrt�eY�t at R6venue AuthOrit,9tl by N9p.Rav.Stat.§§77-202(1)(c)8nd(d),end 6D-3,185,a/K7 603,189 <br /> 96-253-2006 Rav.8-2011 Superser195 98-253-2006 Her.5•2D09 . <br /> pl��pSE RETAIN A CqPY FpR YOUR RECOiiD5. <br />