Laserfiche WebLink
• •TOtIEFILEDWITH Application for Exemption FORM <br /> YOUR COUNTY from Motor VehicleTaxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> *Read instructions on reverse side <br /> •Appliyant's Name \, l ^ � L�CCounry (�L Typed Ownership <br /> //�etorICL` i•gA ��1�]k�1e� [�\Z- �L Number �Corprr ti <br /> Street or Other Mailing Address D � r� �xa l County Number Corporation <br /> \%04 S� ` O t�A.J)( \U l03 ❑Other(specify): <br /> City Slate Where d T5\o r\d �2 L2v c6 ca r State Zip Code <br /> Identify Officers,Directors,or Partners <br /> Title Name,Address,City,State,Zip Code <br /> P2 k -cM \c.L�. <br /> LIST SPECIFIC DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach additional sheet it necessary <br /> Registration Date or Date <br /> Vehicle Make Model Year Body Type Vehicle Identification Number of Acquisition if Newly <br /> Purchased <br /> FORD at-,12• tS%tSei'tcsE+150 IFDFE4ES'SAbA.aotoI 03101 1 l ".2.--) <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> ❑AgriculturaUHorticultural Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> G\ive,detailed description of use,including an explanation it multiple classifications exist: $YES ❑NO <br /> L�ScA Q - 1C SC t a l,i.� Ca it -Ea k a hnrn e If No,give percentage: % <br /> • C. - • 0......a a SA s ► a an ' A <br /> • <br /> (1114k ftke-5 and ±rain Ina <br /> Under penalties of law,I declare that I have examined this application and,to the best of my knowledge and belief,it is correct and <br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization owning said property does not <br /> discriminate iinmeembership or employment based on race,color,or national origin. <br /> sign /J�. ��, -- C !- �? /� �l <br /> here I Authorized tore Title Date <br /> ■ PMYK-Y TREASURER'S RECOMMENDATION <br /> RECENT I- , t.' I!.s$: 77-2o: <br /> APPROVAL COMMEN 'S: t "',`•- <br /> ❑DISAPPROVA k MAR - 7 2013 <br /> �i/�- 3-7 i3 <br /> • /HILL COUNTY ,SignaC=i�nty Treasurer Date <br /> GRAND ISLAND,NE UNTY BOARD OF EQUALIZATION USE ONLY <br /> 4 APPROVAL COMMENTS: <br /> ❑DISAPPROVAL / J-VO1 MCI <br /> • 'uthorize•Signature r Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§77-202(1 Xcltd),§60-3.185§603.189 <br /> 96-253-2006 Rev.5-2009 Supersedes 96-253-2006 Re+.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />