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j/ <br /> 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 /> •Applicants Name Type of Ownership <br /> ORPHAN GRAIN TRAIN ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 427 N SHADY BEND RD {PO BOX 1565 %d"{_5k.---y' piss ltr-j6) HALL ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br />• <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br />• Title Name,Address,City,State,Zip Code <br /> i 16 r-flue '-4 pi RK.;R5 er Cagy UJi k, 5"S35nnaCA 1t14 J'-,0, 6rA-0-3O zsga-iviD, iii,t--; 4c( <br /> ,55' IPfr "+ er.— LsJcc'11-1 0eRG. <9a 974✓P_ Ken/.-xiet /VC 69.'l5 <br /> Sect+--e Y Rent) iiUAi1/ f tt S36 tY 61;i/sodit„ $LL'ii lfi( ( f--: <br /> G9?so <br /> 7`/2,�,/c/riure_r Beth t7aRh' , 8-4- 15'7 -<-N > D N!- ?gi <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary, <br /> I Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date ol Acquisition, <br /> if Newly Purcha sed <br /> -OAS o oo_ A G ci f alba.66 a 0-Aii3iiy7 _ <br /> aoiO 1"'rniii.r I <br /> 5i/.i! dtofnt 56496'a <br /> o 0 62 G'• oo� <br /> 1/,`nc MI It �'i 1 i • h 1 - , ' .3 _•1 A. Y <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaUHorticultural 111 Educational 1111 Religious ,Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: IgYES ❑NO <br /> v560 For% /c'at!G✓G act+t-i-. asj 5,4J1 0 elAl& P(IiCP /re' s <br /> • uc 8 1- - P( G UL:A?`6 0 G/.o >f'l& C. ter`P tae�et e `"�If No,give percentage of exempt use: <br /> So,( oi-ies , sr," Ceionh-G.:L Are . <br /> cop-ri}cj — 6fi+12y Gv i tcM 3 o 3 - 3s e .- 6 a?3 5 <br /> Under penalties of law,I declare that 1 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 - }°r /f�5 — / 3 <br /> here Aut4natu7 <br /> r Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> �j�� �2 A . AA- et...,---��". ..: <br /> ❑APPROVAL COMMENTS: ^""/` / <br /> ❑DISAPPROVAL <br /> >4f�}71 ‘ ` 1d ' / -‘--"3- <br /> /Signature of County Treasurer Date <br /> ,,,���((( FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> �L APPROVAL COMMENTS: <br /> /❑ DISAPPROVAL <br /> III I I► ' <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rea Stat.§§77-202111(cl and(d),and 60.3,185,and 60-3189 <br /> 96-253-2006 Rev.82011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />