01/15/2013 - Laserfiche WebLink

Home Browse Search

efL..---e___ Application for Exemption FORM Nebraska Department of •- REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 •TO be flied with your county treasurer. •Read instructions on reverse side. Applicant's Name i Type of Ownership a cx 1 InfAu.4- -r t.•L c Lr ale ,[,.,_,Tnc, VNonprafit Street or Other Mailing Address County Corporation 1IB DI S €aa,y SA- P o as X \`6103 A L._ ❑Other(specify): City - 1 State Zip Code State Where Incorporated City ,-,, :Cs\QI . 1 4- b no D. 1 IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION Title Name,Address,City,State,Zip Code Pew 1\44p c-hed- DESCRIPTION OF THE MOTOR VEHICLES •Attach an additional sheet,if necessary. Registration Date or Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, if Newfy Purchased NykNDA= adt3 4 UR •KM1kS.•T5kc ci bLtobS77l, /W' /i- i Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively ❑Agricultural/Horticultural Educational ❑ Religious ❑Charitable ❑Cemetery as indicated? Give detailed description of use,including an explanation if multiple Suse classifications exist: IXIYES ❑NO V e•'(N\[',�• '�,'�(_ 6�1" V� UOOtf31 )TZ) `Q{llks� �jpp�wr�( IfJ No,'give percentage of exempt use: • b 1.,s,r e.ss ''....sta`°-"3 4-"t-6‘nik 61‘e A\•b - 4. r Sjp c'.a'y.A.- \oca*' — 5Are`s �.I.ess 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 also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate in membership or employmen ed on race,color,or national origin. illithA // nn / , here Aut •rize•Signatur / Title Date FOR COUNTY TREASURER RECOMMENDATION APPROVAL COMMENTS: -^� �[/S:5 77 `9C.2- • ❑DISAPPROVAL � � /i / (4d124"1-A"' ` j ,w—' '� It Signature of County Treasurer Date min L. UNTY BOARD OF EQUALIZATION USE ONLY V i.mot APPRO 'L CO MENTS: ❑DISAPPROVAL DEC 1 3 2012 HALL COUNTY ��ri e !7i'�- -� �� oja IIP TREASURERS OFFICE Authoriz-• ignature �� to GRAND ISt.AND.NESRAKSA Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,105,and 60-3,169 96-253-2006 Rev.6-2011 Supersedes 96-253-2006 Rev.5-2009 PLEASE RETAIN A COPY FOR YOUR RECORDS.