Laserfiche WebLink
ern.----e___ Application for Exemption FORM <br /> D <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 Na d Type of Ownership <br /> X16 t iz e. CA-risA CCewkr - pNonprolk <br /> Street or Other Mailing Address / � Court Corporation <br /> r/tJ�'W/ /�r l'�F-7A'J//[tV //!/`� // lg// ❑Other(specify): <br /> &41 MC -.L- /Q?/ - n State /o Zia ?9'®� State Where�,nporpnratad <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION . <br /> Title Name,Address,City State,Zip Code <br /> . <br /> .. . Al / it--: , , L , / 'III _ _ :l A/ ' G'. , l '; l <br /> -rinZralliMIM Pi DESCRIPTION OF THE MOTOR VEHICLES • <br /> *Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> nit P_1Ab10/Lt /19'g I/'d Salem i 6-IVEV1(Y91A.9170 /2/LS/alt <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 pf use classifications exist idI VES ❑NO <br /> nil, l✓ekide- ie,7/ de, k,, ./ I>' Trentws-t If No,give percentage of exempt use: <br /> 91�g cet4 r seta/ earl G%9a S 4? Lt5 , % <br /> Under penalties of law,I declare that I have examined this app s:Sin and that it is,to doe best of my knowledge and belief,tore,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption applcalion,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 /> rthtture he a Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> le <br /> APPROVAL <br /> 77 <br /> REC O IV BASSURERRA, 1At 4 d <br /> ❑DISAPPROVAL <br /> WAR - 1 2O ^.�loo 3-sr3 <br /> Signature Treasurer <br /> Date <br /> 1nCR6 UNTY®ARD OF EQUALIZATION USE ONLY HALL <br /> GRAND ISLAND,NEBRASKA <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL // <br /> -W4 - __ •i7L,Ii/ %- '_irL c t A, X-T <br /> 4.7e.n7!Sigrature-r Date <br /> Nebraska Department of Revenue Authorized by Neb.Rem Stet§4 77-202(1)(e)and(d),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 />