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2d <br /> Nam= -- Application for Exemption FORM <br /> Nebraska Depanment of <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 /> IDApplicant's Name Type of Ownership <br /> YMCA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 221 E SOUTH FRONT ST HALL ❑other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title /1 ��/j �NQam��e,Address,City,State,Zip Code A /r�� �+ / <br /> tccr��y�[J irejr°�j�fAnt ,7 y 2.r Cc: ,_ 'ci((A her ar-15 Ki,,side Dr. C'rc, /Sror°�/IUc?. e�l <br />• <br /> :00, tflee O e1iO'a RoL ..PerfrrU37go Frosf,/�rrr 4v.i.te (ra is/gq . fir. 6�'2'23 <br /> teerlSecretev �vi.1 $$G, e 51 jusi� /e �, C/_/c. o 'Nz W.2i <br /> t0Grr..1 T✓e45 "r-r fit r Rm Lov erWa0K &Yeyf l—J�/ Mis,c/(' 44 4 J3 <br /> Yom Eirece,7iiVe %reefer or L4str1 221 st $. t/t Frnfrz J// (iro4) lsl.. ; �. 6S10/ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> 7.1o1oFVefiidle Make - moue-near -- -Body Type Vehicle ID Number Dale ot s <br /> i _ - <br /> if Newly Purchaser[ <br /> o 1593 liar+ 1 fPss 5..2 n elf 83,1 a7a Gy ✓v <br /> 1192 Uc vi 1t SS31 HOA)M9Y996 r / <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious IYKaritable ❑Cemetery as indicated? <br /> Give detailed description of use.including an explanation if multiple use classifications exist: y/— YES ❑NO <br /> b --t vanf are Px G/l4S/�lie'/ cusreoQ in Sti O Apr/ d if No,give percentage of exempt use: <br /> /2DialP All 7` cause and Al 1ssievt , �� <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 .______ ' • rsiress LI Jhce A— /7/00/3 <br /> here I Authorized Signature Title Date <br /> FOR COU TREASURER RECOMMENDATION 7 <br /> RECEIV DD „ , 7;. -05 #77-pc-- <br /> APPROVAL NOV 1�DMMENT / "" <br /> ❑DISAPPROVAL N 5 201 *Q� /./T n / <br /> HALL COUNTY Signature orCounty Treasurer Date <br /> AND n3 <br /> GRAND IS, NTY OARD OF EQUALIZATION USE ONLY <br />• <br /> Awn N <br /> AAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)end(d),and 60-3,186 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 />