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20/4/ <br /> intSZ-- - Application for Exemption FORM <br /> Nebraska Papa rtnsent 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 /> plicant's Name Type of Ownership <br /> CENTER FOR INDEPENDENT LIVING N Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3208 W COLLEGE ST 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 Name,Address,City,State,Zip Code <br /> Pr ec;cleat linters'rn jewtc [n- i<olb /abL "ohc-t, -Ceti r d rif NE teXS,3i <br /> Secret-6 r3 m.l-u, G,(&Pnwaii 34a3 and A.e ste i Poeox 2a3-t) Kearnel, MEhOUSl <br /> Ranch T e ( 4ICrlt it 344 tit• 41 nden AU e, rM nden MC (o'4 s 1 <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 /> ®t.r,Q) if Newly Purchased <br /> f6M Tiros(IC St 004n t4-dr. Stortan 1rAFi'53LI.4N4 11ao53 <br /> -FhrA 'T&LarLc. , 037 4-dr Sed¢ 11AFP53Ltix'7A1toa5.0 <br /> .LLt CK Reta( i 5 e st 'R /dupe SPOre a g4 Los;la,hl/h /t17304,3 <br /> (°.hPU4 `'rtljalQL LS 0DO .�G1Lt)44 S5K55? 3 //v <br /> Exempt Uses of Motor ehicle: Are the motor vehicles used exclusively <br /> Agricultural/Horticultural ducational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> 111 <br /> Give detailed description of use,including an explanation it multiple use classifications exist: ES ❑NO <br /> ali n©n_p rOT:-fr oval ll —&Ert p r i J f c1 e s ar u o-v F Ly O� If No,give percentage of exempt use: <br /> �ero;ces <br /> -to 7nd;Jl;duals R1:-1h 5tyn;f;can� <br /> c aL: 1,'-kiec J :fly in 4-he i- horn6_`, and <br /> Co mmun ;ties <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 l 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 /> a---/ <br /> sign ; % 1 ut.A. , ' �_. __r__ I , i /(3J/ 3 <br /> here Au ized Signature Title •ate <br /> FOR-COUNTY TREASURER RECOMMENDATION <br /> ,_,,,r/ RECEIVED � A <br /> L2�APPROVA COMMENTS: ,,R"'•' ""�'4` <br /> ❑DISAPPRfo AL NOV 2 2 C013 <br /> 1e_a Ar-- /- -- —'v <br /> HALL COUNTY Slgnatu my Treasurer Date <br /> TRCASURCRG orrlCF <br /> [3RAb ISLAND NE etwatCOU ITV BOARD OF EQUALIZATION USE ONLY 1 <br /> [APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / M ` �`�_ ' /-/h�-rr10/� <br /> III <br /> It Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(16c)and(d),and 60-3,185.and 603,169 <br /> 96253-2006 Rev.8-2011 Supersedes 96253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />