Laserfiche WebLink
met--e— 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 /> Appli ant's Name Type of Ownership <br /> WO P- R-I os e MsevAz 'k of 6n giclicriprofit <br /> Street or Other Mailing Address \ Ate- County Corporation <br /> 3ba.€ �1—lb b£ma AL6 -{—lAi ❑Other(specify): <br /> CiryM` �� ` � State ��opCode State Where Incorporated <br /> Mb IDENTIFY OFFFFIIICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> t'kSTeo-/Pilk rilc-mr AAA 2..} t' E2BerK <br /> fo3 Sa66woe1 b Au e, C 9a ) -7sL .i1D£ 6iPo3 <br /> S°F�zcTAp�l '4(KELtIA-R-F f(Pf Se S, McvWQ STGMab <br /> .21,i� At &&'&'O3 <br /> 'RSL4�-F - Mf4Q/L sotpZ 4 ,, gso 7EyL(L/6 gb, Au2cvU/ A)i (a g' <br /> / <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 /> ( lwsS,� , vv1 & n5eXj-I" I- • IOU PPE6'ZISWOZO98s <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br />• ❑Agricultural/Horticultural ❑Educational 2 Rligi <br /> eous ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an ee Iaannation if multiple use classifications exist: �,-,7,✓n�� ES ❑NO <br /> _a bs 11 SGL 10 r s-c - cN U�� . Qu I PM"' ' Cu� A-� If No,give percentage of exempt use: <br /> ! bWi) mow02. J SA1®2A, awc�n- . R Rcq -re 44u� _ % <br /> 4 C'i9A1 ;S <br /> 4 c �✓7,m <br /> l,l>,c,GA-�-e- -lb F'� yoNTk + c�+I��rr�w5 CA-01 <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 ,./i.� ,, �' �� ���%�.,y` `� 3—f3 <br /> here oriz-•Signature' Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> RECEIVED � m,a� _Ater , CS' -#77 —74°.2 <br /> APPROVAL MENTS: <br /> ❑DISAPPROVAL <br /> APR - 3 2013 /` 6'� -� 5-%3 <br /> Signature of my Treasurer Date <br /> HALL C <br /> TREASUREFIZAMOUNTY BOARD OF EQUALIZATION USE ONLY <br /> bkAND ISLAND,NEBRASKA <br />• <br /> APPROVAL COMMENTS: <br />• <br /> p DISAPPROVAL <br /> tea _./.40/tif-is. - L q7a00. <br /> uthori 4-•Signature D to <br />• <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§577-202(1)(c)and(d),and 604185,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 />• <br />