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X0/3 <br /> ^ " � <br /> - ' - Application for Exemption FORM <br /> Nebraska Department of <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 /> isYWCA OF GRAND ISLAND rViCMprofit <br /> Street or Other Mailing Address County Corporation <br /> 211 E FONNER PARK RD HALL ❑Other(specify): <br /> City State Zip Code Stale 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 /> -y`-e.S '1.-}.c /915 w ol"'S4- a ac. 6esoi <br /> re , ftr c c K�.%.no\cars zloa�4 4.i✓k�or, Ac 1 4S adrsta.1sAo '6 / <br /> scc. Tom% (Deers-kitd 51b t. ite.n.`,%Sir ISZ.A c bseo1 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> -Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Modellear Body Type Vehicle ID Number Date of Acquisition, <br /> it Newly-Purchased _ <br /> 55r lam/ Club WDA on /PBS z/b � /8d <br /> rY nyn n <br /> /9,n ( l / PPa0/ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> as indicated?❑Agricultural/Horticultural �ducationai ❑Religious Charitable ❑Cemetery <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ❑YES ❑NO <br /> �/do /,an D f' ill./720 j //�Z g�/�4h No,give percentage of exempt use: <br /> t(om 3Te400/ 9/CJ&9 „c <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 employ ent based on race,color,or national origin. <br /> sig /1s-iie <br /> her Authorized Si Lure Title Date <br /> — 'frUH OUNTYTREASURER RECOMMENDATION <br /> RECEIVED ,.a .r/is J7-,?e:D� <br /> RAISPROVA_ COM BENTS: <br /> ❑DISAPPROVAL ,,,� , - <br /> ( -s aY0_�Qa-AJ // -erg-/a, <br /> H t r 1'Jr:i V 11 Signature of County Treasurer Date <br /> •TRrx ;,::FFICE 9 IY <br /> «- rr{AN).'', .: M1ltr RA' JNTY BOARD OF EQUALIZATION USE ONLY I <br /> 4a rARPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> - � /--/S-�of <br /> 0 <'r Authorized Signature Dale <br /> Nebraska Department of Revenue Authorized by Nab.Rev.Stab§§77-202(1)(c)and(d),and 60-3,185,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 />