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t <br /> �D /3 <br /> '"'_ "�— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed wbh your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> • <br /> BIKES AND TRYKES OF CENTRAL NE ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3004 W FAIDLEY AVE HALL Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Pr LS r(lyn— SARI Seal—Cow, 2o4 R St S L ftc', MC. (DS171x <br /> U.Lk.`9reS,amt.-- lend CIA 4nare. 204 t3$1-- Sh.lL,, Pc (still <br /> C.a.. 011. idkyq�. Lt Ce'+a,.*-i t. Ct- y- Ile Pc Cr AL LaSib3 <br /> True Ltd); D+v,LJ b ks 2-u4 M aO /J(• 64 to <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 /> __ - _ _ _.—_ _ --._. ._ . ___.___. -.— —R Newly Purchased _. - - <br /> KL- Trn:\a vS 701-1- 17-It•T 6"l? A-€F Ho Z4 CM5tt4`ci 1/27/1 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturafHorticulturai ❑Educational ❑Religious lja Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: fp YES 0 N <br /> tlo e- c.sC- c nafl'- Ti; ir S4YU;U-. 01)o.v.tZS-'Fl cn - LPL- fw 00, <br /> 11 If No,give percentage of exempt use: <br /> !4-htrc.P A;c-• A,ilu1 $0,� a,Sabl.A ,rc\iu L cLe\s. 1-1.,. Arp..ur W.tI 6a_ q <br /> tiz c l �w LA b,L !ro bit._ C:t}i,,o, <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 /> sign �p 1115/it <br /> here 11 Authorized lure The Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> QAPPRO .•L RECEIVED CO MENTS: , IAN 4?--C-C- *4 7?-.2c _ <br /> ❑DISAP•'OVAL <br /> C /� /� <br /> NOV — 6 /J/yys�AicgzGa..t. //- -l2-, <br /> It Signature o County Treasurer Date <br /> MALI.COUNTY FOR OUNTY BOARD OF EQUALIZATION USE ONLY <br /> Gr"`" %'S1AND, NEBRASKA <br /> APPROVAL •MMENTS: <br /> ❑DISAPPROVAL / <br /> •uthoriz-• Ignatu / Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 6D-3,185,and 603,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.62009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />