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ert--e— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be Bled with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant Name �/^)_ l Type of Ownership <br /> 15 ICJ IA. cit J)10S CO'enetec `lonpraut <br /> Street or Other Mailing Address 7 /n�,�� [i .p�` /1 / / /,� County'1 �l "Corporation <br /> 22 2l A lJ e.Q. P-0 R ( 4. ( thne i$'Bwi At t�07f R>". I-kettk ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 1-Paskrt-c IRenie Lore/2_ 5123 • n act, ii-tlem Genef is I 0 n.€ 6-ar3 <br /> I)%tee Ccc, le3 .,- ilea d I wt. .4- - 1244 F-ru.1 / ,,,0, G.1F�O/ <br /> , mow- - e c i .': . !_ Le_ g,.., • . / _,r <br /> v t--ee`a-Lrv,-- 6 nn Lli. e7 _414✓he 1 , 24110 Ili N,. 1' FP.n . iSnr ro t a`D'OJ7 <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 /> If Newly Purchased <br /> }Aonc ck 2on-1 LA cbe-c- ''#Pia?G,ZLISVIRIM IZ I 01117 . <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ES ❑NO C-terC <br /> 5 . -t) t 1 C 'it n L '--g, 3 3t. L.i. 'lf ,�-�S�V� <br /> If No,give percentage of exempt use: <br /> �P4w4f.--e-- J�Ci�c. IS cyi S ....ems//did e, <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 hip or employment based on race,color,or national origin. <br /> sign' <br /> T <br /> Stu 12112. 112.__ <br /> here Authorized Signature Date <br /> FOR COUNTYTREASURER RECOMMENDATION <br /> APPROVAL COMMENTS: S431- /2"-aJ /4/-C7-5". 7 7 .7°\ \ <br /> El DISAPPROVAL <br /> \ <br /> Signature of County Treasurer _ Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> KAPPROVAL COMMENTS: <br /> ❑J DISAPPROVAL <br /> RECEIVED , ° e� ate /n,6t <br /> Nebraska Capartrneof of Authorized by Neb.Rev.Slat.%71-202(1)(e)and(d),and 603.165,and 60-3,189 <br /> 96-253-220.Res 8-2011 de 3- ev.52009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRAKSA <br />