Laserfiche WebLink
6 il•►%�---z-- Application for Exemption FORM <br /> Nebr•aska 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 Type of Ownership <br /> NEBRASKA STATE FAIR BOARD ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> PO BOX 1387 HALL ❑Other(specify): <br /> City State Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title �t �/ / Name,Address,City,State,Zip Code <br /> *See KYfAGIe ) <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 /> /_'lvvrelei- intro IA Zo03 Sedan 2n kip 55-8-331.317047 <br /> 1'how-vitt impala 2009 S darn 261INF52672442474h5 <br /> eivurnlc+ Sdvcrado 2003 N2 ion hruck 1GCtk14TS32.276743 <br /> Exel�m.�pft Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> IVI Agricultural/Horticultural ❑Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> �Giivve�detailed description of use,including an explanation if multiple use classifications exist: �'" p LNYES ❑NO <br /> 1 csc- Cov.�yyy Vat;ci� as Iis 4 by At_ NcJon&st-cr,-( S'{1[_, 642424 If No,give percentage of exempt use: <br /> NrtGt c:aAMA re-' dW„t4 Sf t4 CA II154.. . Ile_ NC.bn sk&& <br /> StLaY'Y.r of TYAVicUi{u,yr,. t5 0. sot CC.)s Corpondi inn . <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 membershi•or employment based on race,color,or national origin. <br /> sig »' ” rr <br /> IN I 12 <br /> here Authon ed Signet-r, itle Date <br /> ✓ •R COUNTY TREASURER RECOMMENDATION <br /> Et APPROVAL RECEI t-' C IMMENTS: •4114 "yZ -445's 77-Sect <br /> ❑DISAP 'ROYAL itG,, 1 2012 <br /> 11'�� 8 t (�.'___ 41°%.+�-/,q <br /> •UN'ry lI SignatureofC linty Treasurer Date <br /> TREASURER • ..ASKAFOR OUNTY BOARD OF EQUALIZATION USE ONLY <br /> AAPPROVAL COMMENTS: <br /> ffVVff❑D DISAPPROVAL <br /> _1 <br /> uthoriz'•Signature Date <br /> Nebraska Department M Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(8),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />