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<br /> e a- 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 /> pplicant's Name Type of Ownership
<br /> BIKES AND TRYKES OF CENTRAL NEBRASKA ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 3004 W FAIDLEY AVE HALL ❑other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68803 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title 1 Name,Address,City,State,Zip Code
<br /> P e 5&vA Saint Sett„, zoo $ Slr••-- She.}Io„,DE to t7b
<br /> 11cm_ Pin all' POWC floarPoS 204 B t1/4tkl- SIukert UE (,8M
<br /> 5.,,, Wor 132 N Uc I L.4 ie.- l On•.hp )UE 45131
<br /> _Treat, hn7C)k Dan.ke 130) Anon Dr;..c_°-373 (crawAisknd 'UF 48e03
<br /> f 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 Dale of Acquisition,
<br /> If Newly Purchased
<br /> RCTralers 301x, 11.11oT c&, S Itc:L4CM5lt4sl .
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> El Agricultural/Horticultural ❑Educational ❑Religious 'Charitable ❑Cemetery as indicated?
<br /> 1 tc'-
<br /> Give detailed description of use,including art it multiple use classifications1exist: 3]YES ❑NO
<br /> 41 Wt Oft. A rOtnfr01't1I 5ecJ+v... ar NGNiic-Tip,, — we,. PrDVi C� If No,give percentage of exempt use:
<br /> O
<br /> +4\e y-cr-Tice -Vii\co cove (&LSc.soU i ivS;U ,„,.1.s. X1.1 -in—vr .).\\ lot
<br /> L su\ \. ho.v,\ k3,1,..u. 40 File. .r,la iris
<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 , i.� And_ .-p,.,,,ii-J- ■I 16113
<br /> here Authorized Signature Title Date
<br /> FOR Q UNTY TREASURER RECOMMENDATION 7
<br /> RECEIVED .f " T CO,,a, sni.5.' A-7 4t 2'
<br /> 4PROVAL COMMENTS:
<br /> ❑DISAPPROVAL NOV 1 8 2313
<br /> ` .3
<br /> 7— -°/V'
<br /> HALL COUNTY /Signatureof unty Treasurer Date
<br /> TRFFAJUKNKS OHhI &COU ITT BOARD OF EQUALIZATION USE ONLY
<br /> /WAND IRI AND,NE
<br /> APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<br /> • • Authorized Signature -- Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)end(d),and 60-3.185,and 60-3.189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.62009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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