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inen---z__ Application for Exemption FORM
<br /> Nebraska Department of
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be filed wah your county treasurer.
<br /> aaa •Reed instructions on reverse side.
<br /> •Applic nt's Name // Type of Ownership
<br /> Ir'pAfitti lSr0.4•i N 1'n 1L✓ &Nonprofit
<br /> Street or Other Mailing Address/z �t ar4-f,;.,u - Pd. s6?C /56„5- County Corporation
<br /> 'I`.at A/ /4113))413 F AS AL CZ 4 14.5- "7.e*y M 6..31Q/ ❑Other(specify):
<br /> City State tp'Code State Where Incorporated
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,Stale,Zip Code
<br /> $Rfdf1CK m n:A4rA .5-6-5 .9-r46tzoaeif/Z0 ; C,C,p*NA `!" 3aiulf Nei 6,9B et -C1M4doot6-c F(
<br /> f+St BiZ m 11-11./a6 Cya, /A ve RA/ 2 r PCP , egoi re4 Aut. , /Kcm.f-n,.y Nu 6kge
<br /> 1-ec•4,--c.T(v r•f �iRo 15( diet c%ial X. , C3a f �r !/Sbiv ,<r) 8L c'-e Iar r i. A)e - 7.3 e>
<br /> -tie gc f✓r-tr S+( sy'cRk r'XL> 48,--2c /5-7 .ZNL/tr.�A_ nia 4 ell y
<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 /> lf,NC ef1-ko gQ-d /785 !'no*rA acne- G -02V/3r6.?/re/ S'/-Hib;law) /V/' F/3
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> El Agricultural/Horticultural El Educational El Religious 1Zr Charitable E1 Cemetery as indicated?
<br /> fu iii
<br /> �Gi�ve detailed ix of use,including an explanatiyt it multiple use classifications exist: ,jYES ❑NO
<br /> t_LJ(i I Fx 63-je.al• l-t ..✓t . I-n't'.0 t r-+^J
<br /> O�(� 7pT ;.i�„� T/^,..t,-7- .,i- '- °'" °`'- 1—' It No,give percentage of exempt use:
<br /> / 'wo 61 60 r" pRte-e. 17-44 0/ 6rf :e.1kfros r
<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 � (a}ta 8.Piafout Ani:>rt6E� i02—/9-i3
<br /> here 'Authorized Sio9a re Title Date
<br /> ',y Sig
<br /> FFOO}R COUNTY TREASURER RECOMMENDATION
<br />•
<br /> *APPROVAL RECE(VEV MMEN1S: _ ,"eft— ' ' s ��y �
<br /> ❑ DISAPPROVAI
<br /> DEC 1 9 2013 ,� a A-- /-3.-.,,,t Signatu a of ounty Treasurer Date
<br /> HALL COUfOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> TREASURERS OFFICE
<br /> GRAND ISLAND,NEBR•
<br /> KAPPROVAL 'MC: S:
<br /> ❑DISAPPROVAL
<br /> e 4--2._ ,�ea�o2aii
<br /> Authorized Signature ate
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,105,end 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.
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