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I <br /> 12/18/2013 11:34 FAX 308 385 5061 Hall CD DRY 110002/0002 <br /> . <br /> • 1 Application for Exemption FORM I i <br /> EMIA from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457•To be Nsdwith tomenunty tnnursr. •Ya71 ��I <br /> •Read InstruCNOM en reverie aide. <br /> APPIbm'ta Name iypsaf0mw <br /> EPWORTH VILLAGE INC banmogt , <br /> Swat or Ghat MaIn9Address County ®Corporation iiI,. <br /> 2317 N KRUSE HALL D Mix feP YT <br /> City aura lb cede State Whets Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNER$OPINE NONPROFIT ORGANIZATION <br /> 7 <br /> None,Adrlraa, 'Stale,Zip Code _ <br /> ,esrr(on1 15,/ )rn/t/ coal Jc/nekOn k6 <br /> \J., NNra51c'6Prd nr.�9y /•J611 6,,,„,-.r7F <br /> \0rreinrq Do 0 icrrf YorkAJf I.,,,,... <br /> i <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attsch an additional sheet,It necessary. <br /> Raglahanan Oar or <br /> Motor Vehicle Pete MadMYerr ImgTyp• Vehicle D Nwetw Dere cfland. <br /> If Newly l9maaaead <br /> ( . e to \}ran c SS31LC1(noA I:1 <br /> Z f-nr A -20 S ira,s1-r_t_ • .2 Fin? 4 5 76 X S. — <br /> • <br /> Exempt Wool Motor Vehicle: Are the motor vehicles used eRlueheb, <br /> IDyam. as Indicated? 1'. <br /> Kld�turNb plural gI Eduwtldei Mggloue VOlartleaie ❑CNrwuaY <br /> LP` TT�� 1 <br /> OW derailed dewapIbe of use,airdlu Ingan vtplanalun I/�a�•mide usedamncauors exist <br /> ( � $ ©10 <br /> S -Vat( LT\',1d Q(T�/� G/00,0 I7 TV�Q ISy�� � If N4 Poo lrenlauaof warmMuse <br /> x <br /> Z.(Ctn.SpOf 1- 5\ac-c 4 rnee \nC3s Cn& Ty\ ad n <br /> I1 <br /> Campu S 1(-\ 4Ork <br /> I <br /> unsay peMMesal kaki declare that I tee examined**application and that It I,p the beat of my knowledge and ballet we,sample*,and correct I iI. <br /> Sc•-. :drat)em duly authorized foalan Ins eaempaatappacma4 and that as argarrtrationawrirgthe above-asred property does notdlaasNxu <br /> in j ._. •awnpbynwrd hand on race,color.or nasal°doh . <br /> here►∎Auu a Manna ✓a�urxlie>rr /�(� °.0/21°��1 3 <br /> I FOR COUNTY TREASURER RECOMMENDATION I 'rigr: <br /> MWROVAr RECEIVEIIOMMEETS: tny .,ar`--42 A'4 '4"77,_ `a_ 'E <br /> DISAPPROVAL <br /> DEC 2 a 2W3 ►5 . e>1°l -� '' /- .'"i '` <br /> gretureacamylllas Otte <br /> E HAl I sill tiny FOR COMITY BOARD OF EQUALIZATION USE ONLY I <br /> TREASURERS OFFICE <br /> 11 GRANO ISLAND,NEBRAS N1UAL API <br /> APPROJAL OOIeeIG�lls: <br /> 0 DISAPPROVAL <br /> ►Amrodaed Signature Osie H <br /> • <br /> • Natasa maperaanra Reap Mew teed by rare Raaaur.M T741021)(0)MOH,neoatea and 9rSiat <br /> 9eassodaraa aaii a awaeare N aaa awasdaw <br /> PLEASE RETAIN A COPY FORYOUR RECORDS. <br /> j <br /> fG <br /> I . <br /> l <br /> T000/T000g1 86ZCZ98Z06 IVA 9T:ST £TOZ/OZ/ZT I�,I'. <br />