Laserfiche WebLink
- -? Application for Exemption FORM <br /> Nebraska Department of <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 - //�! _ - 't, I L Type of Ownership <br /> coca ,1,11 i6 a 4--t e.s r �l eac � G Inc- rirNonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1$04 S £d S P 0 8o X \`%(o3 tit A Lt-- ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> ' canA _T.sla n _ 1 4- b ASD PE- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION i <br /> Title Name,Address,City State,Zip Code <br /> ?e-c A becC <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary, <br /> • Registration Date or <br /> Motor Vehicle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> kA LxN b A S acs∎3 'bit.. �Ml�e.TSAt RI) rJax /Rm �x <br /> - <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural i]e Educational ❑Religious ❑Charitable ❑Cemetery <br /> as indicated? <br /> Give detailed description of use,Including an explanation if multiple uuse classifications exist: //�• 1 (AYES ❑NO <br /> Ve>fl l C 1C t,3,g,lr_ tc• OOp to Al a eavin s/ gatliu I If No,give percentage of exempt use: <br /> %b14,5trve.ss \moo rmv\ Oct\oa .ktDn -1-c, <br /> L�n.c-, �ca_�'� \octnan — 5&ore S <br /> \p,IaSzti.tass <br /> 1x•S.A.- . <br /> • <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 oremployme .,-:d on race,color,or national origin. <br /> sign <br /> id �)-/7 - <br /> ...As W".c /i <br /> here Aut . a:• Signature / e Y <br /> Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ^'� <br /> APPROVAL COMMENTS: /22"--1 ySS 77--V - <br /> ❑DISAPPROVAL <br /> (.�V 4'ca 4g'.--j /g—/-7.-- a9..... <br /> - Signature of County Treasurer Date <br /> RECEIVEDfr.,,,, UNTY BOARD OF EQUALIZATION USE ONLY <br /> 4 APPROVAL CO MENTS: <br /> ❑DISAPPF OVAL DEC 1 3 2012 <br />• HALL COUNTY _�_�! oJ3 <br />• TREASURERS OFFICE Authoriz>• ignature y� ale <br /> GRAND ISLAND,NESRAKSA <br /> Nebraska Department of Revenue Authorized by Neb.Nev.Stat.§§77-202(16c)and(d),and 60-3,185,and 6003.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />