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-7013
<br /> Nebraska Depnt of 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 /> • CENTER FOR INDEPENDENT LIVING ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 3208 W COLLEGE ST HALL ❑Other(specify):
<br /> City Stale Zip Code Stale 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 /> wres;drn_ri ,:,i,,;n 117-b0.5, 17171 44001 y,70a °o" se. Crnnpc lrn, nle 1ox43c
<br /> met Al, -1( 1,, arvan,dti ii 34,73 ,-7^a Pie. Ste ci Pl)&ox.. t., itaarnell >JE bkXW (
<br /> 3nard J0-14 -Kr Ho 314 )4. AI nrlan 1:1-0e - M:nAen OF loX4h`7
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make _. _Model Year i Body Type - -- - Vehicle 10 Number - - Date olaequisition,
<br /> if Newly Purchased
<br /> Coral !urL&S SE AObi° , 44r Sedan. 2F inCP53LL96A11C(a53 '/i0
<br /> Ford ia.Lk rlac , OO'7 LI dr .icdan_ I1--)2F4ti 3ux 7aa(ea;SD l/i0
<br /> Rif ;Lk Re al 1r/a1S et , 'Jran65Pert. r1C;4W gin in15RI710 3 1 /iO
<br /> O 4 our e-0..-r-
<br /> r'h OA/,l "tmleabr, L5 r.7uis 4itr s loft(1.--, an/ ou4 ,5'ikS59,73 l / /D
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> as
<br /> El AgriculturaUHorticultural Educational ❑Religious ❑Charitable ❑Cemetery indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications exist YES ❑NO
<br /> A non- pr-ett (GBnc7 -L-hut row;des 61_ 0cer ; Eby of S�N,'ee
<br /> If No,give percentage of exempt use:
<br /> t ; nd;) :duaIS Pi:4- - S,'yn; :(-4t,-- d�silh; j i 'eS 1I /
<br /> fn -hie: r home and Comm un:ti:PS ,
<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 - �-�. `c stn r �'` �3. )�r , JlI� /l .
<br /> here I Authorizes Signature Tide Date
<br /> - -- - _ --- -- - FOR COUNTY TREASURER RECOMMENDATION I
<br /> E APPROw: EVE' COMMENTS: "6- 7 e, 'S 77-Qc
<br /> ❑DISAPPROVAL NC y _ -. 2012
<br /> L s.° ' +#. /7-9-tee
<br /> 1,41A.Cot!NW •Signature of County Treasurer Date
<br /> Tr"" tr' `''OFF FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> rl Cr .) ,IS' ,,,,,,,A
<br /> FOR
<br /> COMMENTS:
<br /> ❑DISAPPROVAL
<br /> • Authorized Signatu Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§71-202(1)(c)and(d),and 60-3.185,and 60-3,189
<br /> 96-253-2006 Rev.8-2011 Supersedes 98-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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