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01-04-13; 12:05PM;CENTRAL NE CHILD ADVOCACY CENT ;308-385-5238 # 2/ 2 <br /> - <br /> . . , V <br /> • Na ,..e.p.aenmamar + Application for Exemption FORM <br /> NV ! from Motor VehicleTaxes by Oualifying Nonprofit Organizations 457 <br /> •To he filed with your puny treasurer. <br /> •Reed IRSaWdepp1 en rewree side, <br /> APpkara Name Type of Ownership <br /> illCENTRAL NEBRASKA CHILD ADVOCACY CENTER <br /> SlrmeterOther Mulling Address County ®Capomilon <br /> 721 W KOENIG ST PO SOX 844 HALL 10 Other(specify): <br /> GRAND gip Cede State Where InompasS <br /> GRAND ISLAND NE 68802 . NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tice Name,Address.City,Slats Code <br /> .4Z/3R rr trlsT llr . ilre frillitilit i.e . @IiMBEt'JY'f,PWi1Fillirtgt o <br /> .fit t_iarrmiwar:l a • a, ii•1! '(e7�h(a7i/ avirg3 ►_neussassar <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,It necessary, <br /> Registration Dab or <br /> Motor Vehicle Make Model Year Rodylyp• Vehicle ID Number Date of Acquisition, <br /> II New Purchased <br /> ?Bit. _lal'Wan:STiirTAmillrdr�- ri Wi1►affSall aril <br /> Exempt Uses of Moler Vehicle Are the motor vehicles used exclusively <br /> ❑AgrloultutalHotueuitursi ❑Educational ❑Religious ❑Charitable ❑Cemetery es Indicted? <br /> Olve detailed description of use,Including an explanation If multiple use elaaslllcatione edit , kS ONO <br /> akek iS U /,/,//J <br /> Used 14a vela/ to s /67k9 if No,give percentage of exempt use; <br /> • 6clued eNd l eOA/fiie/l1C65' % <br /> z :"^ <br /> 6 r-oi-K, <br /> Under penalties of taw,I declare that I have examined this application and that It Is,to the beet of my knowledge and belief,true,complete,and correct.l <br /> also dean Mail em duy authorized to sign •-exemption application,end that the argenlzallon owning Ito abeve•asted popery does not dlxrlminate <br /> in membership or employment bawd- . a,color,Or national origin, <br /> signer - "- �Xf wi4YF, ✓7j,'Ftho/___62_:/w <br /> here,' then.., Pita Date <br /> I RECEIVED LINTY TREASURER RECOMMENDATION <br /> APPROVAL COMM TS; 7-7.0. > AJSS 97 .off. <br /> 1 <br /> Q DISAPPROVAL ,1 sl - 4 22013 <br /> HALL COUNTY i1 SlgnpZurs umyTeasurer Data <br /> ,hC .Urt ,C.>�,, iC <br /> OiRANP ISLAND NEeRA @.4 CO BOARQ OF EQUALIZATION USE ONLY <br /> -APPROVAL COMMENTS: <br /> ❑DISAPPROVAL / <br /> / <br /> Ignalu{-fie Dale I <br /> AataeG •partment of none *automat by Nets Rev.Stat gg 77730¢(1)(0)one(0),and eb3,t86,and 004,'$v <br /> ab=ep,,e00e Rev,0-2011 Supseedos$W eg.O0e Nev.[-ROOD <br /> • PLEASE RETAIN•COPY FOR YOUR RECORDS. <br />