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��-�-�- Application for Exemption �o�M <br /> Nebraska Department of <br /> REVENUE frbm Mator VEhicle Taxes by�ual"rfying Nanprofit Organizations 45,�, <br /> •To be filed with your county treasurer. <br /> �Read instructions on reuerse side. <br /> Applicant's Name r Type oi Ownership <br /> `.31 � � C�:��� '� W�-�����.' �b�-L CCJl7-�. �Nnnprofit <br /> Street or Other Mailing Ad ress County Corporation <br /> ��a 5� ��-�Q-,rt"' CT°�l' �Other(specify): <br /> City State Zip Code State Where Incorporated <br /> �r�u �5 t.lC G NL-" <br /> Ip�N71FY OFFICERS,DIR�CTORS,OR PARTNERS dF7HE NONPROFIT pRGANIZATIbN <br /> Titie Name,Address,City,State,Zip Code <br /> ' �,'� � i ( 3,� G�, l � <br /> cC ([. i FR. 4 b S. <br /> � �. � S. <br /> ❑ESCRIPTI�N�FTWE MOTaR VEHICLES <br /> •Attach an additienal sheet,if necessary. <br /> Registration Date or <br /> Mntor Vehicle Make Model Year 9ody Type Vehicle IC1 Number Date o}Acquisitipn, <br /> if Newty Purohased <br /> � ; � � �' -1--IZ. <br /> Exempt Uses of Motor Vehicle: � Are the motor vehicles used exclusively <br /> �AgriculturaUHorticultural �}(i Educational I XI Religious ❑Gharitable ❑Cemetery as indicated? <br /> T� 7,.� <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES NO � <br /> 1�, +'f^q,yi�D('��-p Yl � ��C Q..� �`Y� S�-��CY7l ��G If N give perce������ <br /> �f i M GtV"� 'lA$Q. 1 "� J <br /> I•� r `� -+--j-c.� 5c.h oD� --�-Tar�s Ot-�a{��n i <br /> �-V�a t G�Y'�.X� c�� �h e 1� Tr ��5 or � � � <br /> fMa� � 1ASe.� �p� �c�.ri sh -�'�r �e}r-e.�•�S oc G���eF" S�i►1'i�a.�- �(�L 2 � Z��� <br /> 'P�R��SP S� FlALL GC]UNTY <br /> ToFA. <br /> Under penalties of law,I declare lhaf I have examined this application and thai it is,to the best of my knowledge and belief,tru ,cnm let�r�fid•�EOrf�b14ND,NEBR�`SKA <br /> also declare that i am duly authorized to sign this exemption application,and that the orgenization owning the ahove-listed proper y oes not iscriminate <br /> in memf�ership or employment based on race,color,or national origin. <br /> �/ 070 k� U <br /> 4 � <br /> he�e Aur ed ignature 7itle T f� L�ate � � <br /> FOR COUN7YTR�ASUR�R RECOMMENDATION <br /> APPRC7VAL COMMENTS: ��S �7�°�na� <br /> []�15APPRQVAL <br /> �,�,��y,� ��,�—•�� <br /> Signatureo CountyTreasurer Date <br /> FOR COUNTY BDARD pF Et]LJALIZATION USE ONLY <br /> �APPRDVAL COMMENTS: <br /> []d15APPROVAL <br /> 0 <br /> uihorize ignature te <br /> Nebraska�epartment of Revenue Autnorized by Nah.Rav.SteL§§77-202(1)(c)and(d),and 603,185,snd 603,�89 <br /> 96-253-2006 Rev,8-201�Supersedas 96-253-20D6 Aav.5-2009 <br /> PLEASE RETAIN A COPY F�R YpUR RECOR�S. <br />