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aPPif <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 /> Applicant's Name Type of Ownership <br /> YWCA OF GRAND ISLAND ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 211 E FONNER PARK RD HALL ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 1+9 es. •0 -FICNVe- qp 4' Pho€t ti (,t r_. ince31 <br /> c;ss+- 6 Chels Clilr9du <br /> 1821 n. .p• r C 1-1€-EaBcg <br /> - , su_t4ex-,Q_..4. Vfla f I//slp lbrn aie-- ' z IL 1BSO3 <br /> ects to- l± .34'Qj1ti 4-W ll1/4t SA- a.7 HE E <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> _ ___ __ ___- _ _ _ ---__-_ <br /> _ _ _ — �`�eBls rt atTanete or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> FnroL £042, n /. - /Ff35Sa/13z.1A55L <br /> 59 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural Educational ❑Religious Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: <br /> / []NES ❑NO <br /> r- 614 ion e P y L/rn„3 j /�,�� /-/_z ,,en Lr If No,give percentage of exempt use: • <br /> /��� �,[� T/ x/y'y/�f7n/n ///777"”" r..ili <br />• <br /> O //LC. / +0 £� a 4/ <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 auth• ized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> e ership or employme• •ased on race,color,or national origin. / <br /> f <br /> h� e / /i� _��_.}. : /,t! /' <br /> -'Authorized Signal e t e Date <br /> d®n 00tYiTVTREASURER RECOMMENDATION <br /> RECEIVE <br /> APPROVAL COMEN TS: " C 5-5:' ----"Pc <br /> ❑DISAPPROVAL NOV 2 2 2013 <br /> HALL COUNTY It Signature of County Treasurer Date <br /> GRAND ISLAND,NEBR,f89000N-Y BOARD OF EQUALIZATION USE ONLY <br /> MAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL y <br /> zit 1% / <br /> 11 Authorized Signature at <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 603.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />