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„a Departmen to Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> 119r (_`evtier CCr BevrndfceAl fle4kStatre Strides. Z e . - X Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> G 15 ti. £Inn 6-Free+ P-O. gox 17(.3 f-1 A L L ❑Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> Gnand 2414n4 N£. (o$80- /u4 <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Pres:dehf and Cit.) Co Wit Bdt,.kird5 /(OSS 5wsetW4fer AVe, Kecrner�. A)£ (088`/7 <br /> Vitt-Pmident- etd 4 F Joel Chris . 603 L1- kJ street , Crgna ra/40 y A/C- 6• 801 <br /> it See nticc.tt,et) Us} oc Bop <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Faq 1959 Von 1F(35531 - kN Bel /a?Y 9-214_13 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturavHorticultural ❑Educational ❑Religious [M Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple(use classifications exist: ®YES ❑NO <br /> Wee) 4o trgn5(ort cl;enf5 to and n'rc.•-1/4 Serv:te5 . <br /> If No,give percentage of exempt use: <br /> q <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 vP/cPc• 9-50-ao 15 <br /> here Auth• zed Sig .ture Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> VAPPHOVAL RECEIVED4MENT; <br /> ❑DISAPPROVAL <br /> a” 4, 2013 d/,,, ;wpai ,4.,prt (let e7 iaauati 'Waal <br /> Signature of County Tree rer Date <br /> NALL coupes COUNTY 3OARD OF EQUALIZATION USE ONLY <br /> -T1!lAabRErcS Orres <br /> p� GRAND ISLAND,NEBRASKA <br /> T✓I APPROVAL COMMENTS: <br /> l❑CDISAPPROVAL _ <br /> thorized Signature O/ Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />