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iten.---e_--e_____ Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be flied with your county treasurer. <br /> •Read instructions on reverse side. <br /> A p cant's Name {/�� Typee of Ownership <br /> )/M �' riot- 1 )Q�.Y-� Ai Nonprofit <br /> SyO or Other Mailing Address County !'Corporation <br /> 1(-) 1337 1-14.11 ❑Other(specify): <br /> op4 <br /> (�t�1(Jd' SllaE ZZiipppCodde/✓�^� Stale Where$orporated te <br /> ra�� �� IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORCaANIZATION i <br /> Title Name,Address,City,State,Zip Code <br /> *Se-.c 44-At-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 /> etiMAGA" 1 1 2ndµ ��..v 2G i kF 5 2 E 949 247+15 kolld- s till <br /> 7aa3 Y2 -lb?' -1-ruck 14C_EK141-53227/o74K <br /> vvalrt TXyue-Mt 2o12 161JKVSEfl5CT296M I 02/15/ 2613 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ;4 rtk <br /> AgriculturaVHowltural ❑Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation If multiple use classifications exist: <br /> TTT <br /> /ES ❑NO <br /> en <br /> Se- CO eTlomy Ve-LIClC s Ore- tuS eci t io V Toe— N�ras�ca -I eTC- B0`-et If No,give percentage of exempt use: <br /> of 43r;cu l}u v- . oa d C404-6" Cowtalny cast- tri.ly•-IL Mei,rack& <br /> ... ck Boat) ac pve tcum,".„ i S A S O I (c),5 Cat-pay -iiov, . <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 mem•:rship or employment based on race,color,or national origin. <br /> sign b_ <br /> here A h• -red ignature Title Date <br /> ill FOR COUNTY TREASSREERRREECOMMENDATION <br /> eAPPRO AL RECEIVED COMMENTS:yUR" 4? S'� 'r-7"7---7cDa. <br /> • <br /> ❑DISAPPROVAL 8 27 - — <br /> � r-)1(( zut- ,‘,..1- .27/.3 <br /> Signatur o ny Treasurer Date <br /> I TALL CC' <br /> TRFE,SCr-';. -^E FOR COUNTY BOARD OF EOUAUZATION USE ONLY <br /> t,HANU IOLMISU, a._.., ?■ <br /> *APPROVAL COMMENTS: <br /> ❑DISAPPROVAL i <br /> r07- 7//'/_ - _-_ti j0z- <br /> ihoriz••Signaturl Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)end(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 />