|
'0/3
<br /> ^ Application for Exemption FORM
<br /> —z
<br /> Nebraska Department of
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be tiled with your county treasurer.
<br /> •Read instructions on reverse side,
<br /> Applicant's Name Type of Ownership
<br /> ORPHAN GRAIN TRAIN ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 427 N SHADY BEND RD PO BOX 1565 HALL ❑Other(specify):
<br /> City State Zip Code Stale Where Incorporated
<br /> GRAND ISLAND NE 68802 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> BRn,w( MR,0(lc r-A�r Geary WiecK.,55Ssytajec 4 Rd , Cr ,v6 flats'
<br /> Asst 41 i'-c`in.a /SIC �c u4rN baj g, /9aa +i o . ,CR r ■��/= 6 V ats'
<br /> .54c- tc• ciry nail es..4L/JW^. esx. ;5`f : r.,../141.52,-10-6-/ eo?9&[S
<br /> 77-e,..-sc...,'mar- ea-t_it +-war-K Qo2c f5 7 4m-,,-9, #C-
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> Registration Date or
<br /> _Motor Vehicl Meke _ .. - ModetYear body Typo- -Vehicle-ID Number - Date ct Acquisition,-
<br /> it Newly Purchased
<br /> rand TS f 02 cg P�ry Kor JF/su?g45 7ad395i7 -79eAt //
<br /> MpN 4C 4' :ri[ 4rJ ..2 oIa % r-n;c14.r' .0-re4eg/aio4m5a�9�3a 5e�i- /1
<br /> ao 9471-e r Gib �•c oz 7-i-A-1t-e L' 3S4TBih 2XC4O6lZ '1a .114.1( II
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> El Agricultural/Horticultural ❑Educational ❑Religious "Charitable ❑Cemetery as indicated?
<br /> Give detailed description of use,including an explanation it multiple use classifications exist: YES ❑NO
<br /> P/SE,Q for tidy- 'StAn ,¢c4.:,..); 6-5 CI rzs4 •l '(s
<br /> O/ If No,give percentage of exempt use:
<br /> Ir erh1 .1 ��fpL�c5 : /v 1.t,r ire-1.. ,U
<br /> C '14c+ - GA-!R y al ec h 308-ala - oaz.35
<br /> Under penalties of 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 declare 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 or employment based on race,color,or national origin.
<br /> ■
<br /> sign _� — Grp L .9.-c-,..t-X /? czr— fa- -/.2-
<br /> here Authorized Signet Title Date
<br /> FOR COUNTY TREASURER RECOMMENDATION I
<br /> W
<br /> PRO
<br /> L RECEIVED co COMMENTS: 4 _ _- d //45:-5"
<br /> `5 77-`2©`a
<br /> ❑DISAPP 3OVAL
<br /> fEG - 4 2012
<br /> yPrX Q- i-7--r,-.7
<br /> VA 6•�:duTY . Signature of County Treasurer Date
<br /> TREASURERS CEA 1 FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL ---010,4-4
<br /> • _,u horize• ignature r Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet,§§77-202(1)(c)and(d),and 603,185,and 60-3,189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
<br />
|