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men--z-- 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 /> .App'cant's Name�.tl' -� Type of Ownership <br /> 1�e.Ytra ck& ILIA'v° r ttr L Joc re) Ai Nonprofit <br /> $ eet or Other Marling Address Coy ty J"Corporation <br /> PO Eax 1337 141 I ❑Omer(specify): <br /> tyrMhI J cI nA NE Zip2707 State Wh�eln�rorpomtetl <br /> 1/'i IJ3'l IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> *cxc A*}de-kJ <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 /> t^ Ayala imtaiqq aooy c,AiLii 261.tOF5 2 1749247441 5 <br /> kwrole ' 5; vont* 200. V2 -10„ +runic sae_EKiµ"S53227L742- <br /> rite vvbi - 1-„ur_vs._ 2o12 S6 MKVGEfSCT29Lo41 oz/151 z033 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> PgAgriculturalMorticultural ❑Educational ❑Religious ❑Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ES ❑NO <br /> i f { x` .( sk n 777""""”" <br /> �G COVY�0.YlY lyC-Y�1C:l!-5 on- �E� Loy 4-Le- Me.-to rZl�t�cGl ��0�'r` '^x�^ It No,give percentage of exempt use: <br /> o �(r;cut+ur/L & 4 S-Fa4{' _co.,- cUvv,kuu ty us>z a kv.—The_ N\do rastcA <br /> Ca Bond & 1:ktc_u-FIV c_ t 5 A SO l (c)S Ctrparw-hovn . <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 or employment based on race,color,or national origin. <br /> sign ,_ �, t �_ ._. _� t Y. �%. i. .. " !.. 62/26/13 <br /> here ' hor'ed/ignature Title FOR COUNTY Date <br /> TREASURER RECOMMENDATION <br /> APPRO AL RECEIVED CO IMENTS: /> 22.4-1 4?S T 6--7. Qea. <br /> ❑DISAPP 3OVAL <br /> FEB 2-7 <br /> Signatur o ounty Treasurer Date <br /> I IAI.L GO'"'N <br /> TRFFS,':"" -'^E FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> (+FtA.NU lot-Ac J` .—_. . ■ <br /> *APPROVAL COMMENTS: <br /> ❑DISAPPROVAL .. <br /> ihodz d Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(e)and(d),and 60-3,185,and 60-3.189 <br /> 96-253-2006 Rev.6-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />