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• <br /> inkon--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 /> 1 n :nrs ante s l (& 14�YYI Cch . So l Type roflt Ownership <br /> ►'a e i ra K orp rata <br /> eet or Other Mai••�Address 9 ,/J l County ��' Corporation <br /> i a. fir ❑Other(specify): <br /> teE State =e Incorporated <br /> a rah S lay h i ���/l &Zy O 1 I <br /> IDENTIFY OFFICERS;DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> rt :me,Address City State,Zip Code a <br /> I r - . e :: — WiNtliril ro . -a. 'l- flf!tZJ <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 /> _ <br /> if Purchased <br /> iL <br /> '11L► . brala it • a eilll►I`.tG7��l.7M,igina1r, <br /> Exempt Uses of Motor Vehicle: �,/ Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious ECharitable ❑Cemetery as�nd�icated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist /1� LEI' ❑ <br /> 10 i 1t be, Li(6CCI by ` Ah∎ Md-1 Ooh�raA Om <br /> c1 CN <br /> / If No,give percentage of exempt use: <br /> +0 �r0-n Spo )05-6 M-rc_�( Oiltd i nJ kre Ui I q <br /> an +( m a�5 cu t\ d -h() f(�h/cova ei 6_14 % (m �aJ 0 O d eS <br /> av Ct Lt uS - or Ct� I aP@rancl isIQnd/ aftledt cjr% <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 coned.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.e ip i. V aL e � <br /> h ored Signature ! rte of 4 <br /> < <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> [IPPROVAL Cer.ur-ni-S: ^ir'"". j--- 4 .S"S' 4 V7-•QOat <br /> ❑DISAPPROVAL <br /> RECEIVED <br /> AUG 1 3 2013 <br /> r �ire Ai -�-•t. /e"/3 <br /> Signature of unty Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND.NEBRPi9IDUMEI.4fS: <br /> ❑DISAPPROVAL rd 7 <br /> Authorized Signatu - Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.44 77-202(1)(0)and(d).end 60-3,185.and 603,189 <br /> 96-253.2008 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />