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. -2913 <br /> Ne�braskaDepeni.-artmf Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> •Applicant's Name Type of Ownership <br /> YMCA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 221 E SOUTH FRONT ST HALL <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City State,Zip Code <br /> re ii . ,# , a 'F c % . � 1 <br /> 1 LLa <br /> t __ _ MA Z� . ' e-rasa <br /> &r- A! '• .'t:o <br /> Pcifirrlfraer eon e O Arne ' ,, a A) �1r ! '. <br /> L. rri?rAa stir / f/ •r [r ry'n !t.. 't39 5 c f .! n,/ ye . ',i3 <br /> yrieli k ee ks.+p Drre 'Tor tart5vvi Pal 0jA. ..t 51. 6eceed fs/� /Vet ,&Wo1 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> -Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type. Vehicle ID Number Date of Acquisition, <br /> _ if Newly P h sad <br /> re;el 17`13 UGh j1 &TS3_ZOR01852o7 ��� /� <br /> Fns f 9a VIA" 2F6'3531koN 48994 / i an/a <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious Charitable ❑Cemetery as indi ated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ES 0 N <br /> !A 1/N SAJ G Y e, ygCit e lit.Poe f�sej / � 5Lt/P_ #t If No,give percentage of exempt use: <br /> Cip frO5ra IM rA t tit- cA s'‘,..0,804-1 <br /> r.. of✓ opt <br /> I /'lout /� -'/ C4 uSQ_ .Cy∎ /sv‘� s510r1 • <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. n ,/ <br /> Sigel ��i__�= C i- inio.,.pi #e53 aare4 /i/rieR <br /> here i Authorized Signature Title Date / <br /> I } FOR COUNTY TREASURER <br /> APPROVAL ✓ ECEIVED COMMENTS: 4 m OI, �_ Al S 77- °74,°2. <br /> ❑DISAPPROVAL ?,:i„! — 0 2012 /> i <br /> se�Ceits� //-6-1.2 <br /> H At.t_OOUtlT`y Signature of ounty Treasurer Date <br /> 7 rx e. ❑C U€,I <br /> c 1 IS:A Lt NeA <br /> .3.RASKA FSR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ip APPROVAL COMMENTS: <br /> ❑DISAPPROVAL —'r <br /> • - thorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 603,189 <br /> 96-253-2006 Rev.6-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />