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��, �,Y�; ��� ��� - �.74y <br /> �►.•��-- Application for Exemption �oRnn <br /> Nebreska�epartnlent of <br /> �c■��E from Mator Vehicle Taxes by Glualifying Nonprofit Organizations 45.7 <br /> C�\ •Ta be filad with your county treasurer. <br /> •Read instructions on reverse side. <br /> ApplicanYs�N� , I� �G� ■/ , 7ype of Ownership <br /> � ���^-' �' 7`«. �Nnnprofit <br /> Street or Other Mailing Address Counry Corporation <br /> !�� f y � � �` �Other(specify)� <br /> Ciry_ � State Zip Code State Where Incqrporated <br /> /=- ��� �1� �8'�'0� �ora�.a- <br /> (�Tf <br /> IDENTIFY pFFICERS,DIR�CTQRS,OR PARTNER5 OF TME NONPROFIT ORGANIZATI�N <br /> Title Name,Address,Gity,State,Zip Code <br /> DESCRIPTIqN DFTHE M070R VEHICLES <br /> •Attach an additional sheet,if n�cessary. <br /> RCglstration Date or <br /> Motor Vehicle Maka Model Year Body rype Vehicle ID Numper Date of Acquisition, <br /> if New Purohased <br /> ve n c -r c. n G � �y T a � <br /> Exempt Uses of Motor Vehicie: Are the motar vehiCles used exclusively <br /> �Agricultural/Horticulturai ❑Educational �Religious ❑CharAable ❑Cemetery �s indicated? <br /> Give etailed des��er+�f��r��i��explanati ii multiple use classifications exist: �YES �NO <br /> 4.H' r <br /> If No,give percentage of exempt use: <br /> % <br /> oer � s zo�z <br /> wa��couN-rv <br /> TRFASUR��S C�F�CE <br /> GF2ANU I.:�_AND,N�E3RASKA <br /> Under penaliies of law,i declare that I have examined this application and that it is,to the best of my knowledge and belief,true,complefe,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the arganization owning the above-listed property does nnt discriminate <br /> in mempership or employment based on race,cnlor,or national origin. <br /> SIgl1 � /4 / / <br /> here putho ized Signature Title f�ate <br /> FD�t COUNTY'fREASUR�R RECOMMENDATION <br /> APPRQVAL COMMENTS: ��O �—' �SS �'4 �� <br /> �DISAPPROVAL <br /> �� � /c�-����� <br /> Sig ature of Counry Treasurer Date <br /> FOFi COUNTY BDARD OF E�UALIXATION USE DNLY <br /> �APPROVAL COMM�NTS: <br /> �171SAPPROVAL <br /> ^ � �C7�U%� <br /> 'thorized Signatur Date <br /> NabraSka�epartment ot Rev9nu0 Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),end 603,195,and 603,189 <br /> g6-25&2006 Rev.8-2017 Supar5edes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A CpPY FOR YDUR REC�RDS. <br />