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TO BE FILEDINITH Application for Exemption FORM <br /> YOUR COUNTY from Motor Vehicle Taxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> 1 C`}., •Read instructions oon_reverse side <br /> Applicant's Name �l .\ �]l c\e 5 S `7ceo cctr t2L�c-Couny \A cLL .Type riNonprofithW <br /> Street or Other Mailing Address County Number Corporation <br /> %OA <br /> Sk Po P ) -k2.103 ❑Other(specify): <br /> city State State Where Cron A T a 2 1p$$t� N <br /> Identify Officers,Directors,or Partners ' <br /> Title Name,Address,City,State,Zip Code <br /> P_ krvkakkc� <br /> • <br /> LIST SPECIFIC DESCRIPTION OFTHE MOTOR VEHICLES • <br /> . •Attach additional sheet N necessary ' <br /> I Registration Date or Date <br /> Vehicle Make Model Year Body Type Vehicle Identification Number of Acquisition it Newly <br /> Purchased <br /> FoRSD. arota. 158t'SeilecE+lrio 1FDFE4FS'aSt b hatIot 03101 l 1 •5 <br /> Sb Cuban- 9 <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> ❑Agn VFb <br /> cueurarticuhurai ®Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Give detailed description of use,including an explanation it multiple classifications exist: jg YES ❑NO <br /> '15CA. Qof p k\<■n e tycl o rid -F-anY'r- hnlrn ° If No,give percentage: % <br /> C. - • .0_11a �1.s • e It al I - <br /> Cie 41\ft4tes C*nci_ -*-.c-cLt n tnQ <br /> Under penalties of law,1 declare that I have examined this application and to the best of my knowledge and belief,it is correct and <br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization owning said property does not <br /> discriminate in membership or employment based on race,color,or national origin. ,,,, ��.�� //,, <br /> sign ( t - C I- b4 3 <br /> here ,Ntthorized ure Title Date <br /> RECEIVE 'I'TREASURER'S RECOMMENDATION ' <br /> APPROVAL ��py COMMENT'S: / ��N, '7?-2O°; <br /> ❑DISAPPROVA_ VAR - 7 2073 <br /> ,G�c � � 3- ?�3 <br /> IIAILCOUNTr Signature of ny Treasurer Date <br /> GRAND ISLAND,NE UNTY BOARD OF EQUALIZATION USE ONLY <br /> 54 APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> or¢ gnature !' Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§77'202(t1(o)(dJ,§60-3.1e5§60-Sias <br /> 96-2534006 Rev-5-2008 Supersedes 96-253-2006 Ray.11-200e <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />