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.., j , 0247,4 <br /> ..,---4- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENREVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> UE G V •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> airpplicant's Name Type of Ownership <br /> NEBRASKA STATE FAIR BOARD ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1811 W 2ND ST STE 440 PO BOX 1387 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 19 cc Ail-ackezi <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> f - - - --- --- - -- - - -- -Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> heatreLei Itxcpata 2004 S1dan 2611\JF52E2y924/74f25 <br /> C vroit+ Carver-4k 2003 r f 2 i-Din-1-ruck 1St'fk1NTS3Z27674E <br /> CVxvvok+ Tv-,.veYSe., 2012 - 4-dear 1 GAM VV( 5C`T29G0V <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> IX/1 Agricultural/Horticultural ❑Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if/multiple use classifications exist: C�,,.[., AYES ❑NO <br /> 1l�Y C. ICC..I__1Md__vfaiJJ Y��K/.I�Cc out.. ascot toy 7111-. kkLi—nzz lit yGait. &turd r If No,give percentage of exempt use: <br /> {igv;cui un—cum' c4 4 -C—corvsan vSt. oNkv . 1 t Mebrat Sl tle— / <br /> JJJJJ&Ora e-f Az�Yicu1ku.re, ';c o. 501 (c)5 corpevs4,n. <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 properly does not discriminate <br /> in member- ip or employment based on race,color,or national origin. <br /> sign i� � . � did . 1.. . ���7�/� <br /> here Au orized I.6ure Title Date <br /> cnn^Cray'REASURER RECOMMENDATION <br /> Mt/APPROVAL t RECEIVED COMMENTS: <br /> • 'fi�E ,_,,, v< '=77 sc-7 <br /> ❑DISAPPROVAL NOV 1 2 2313 f <br /> HALL COUNTY ,Signature of County Treasurer Date <br /> i TREA.SLAND. <br /> GRAND ISLAND, TY BOARD OF EQUALIZATION USE ONLY <br /> so APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> ,(-- re /71 ` /—/`e-0144 <br /> • • Authorized Signature Dale <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)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 />