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ge�-t-- ' 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 /> PROPERTY ASSESSMENT •Read instructions on reverse side. <br /> Applicant's Name . rte. /r r, t 1_,.., Type of Ownership <br /> CelaL t U 1 Thika te5 c (l '�`� t\\-\r[_kIL5L .L 1L �y Nonprofit <br /> `eettt or Other Mailing Address �;(, P (� County `'\ \ Corporation <br /> 1 CA a, 7_II �••L 1 0 i JoV \%63 CAS IBC L ❑Other(specify): <br /> CI r State Zip Code State W re Incorporated <br /> City,. State <br /> L \caInd VJ`z_ 1a%RO2. 2_. <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZA . <br /> Title Name,Address,City,State,Zip Code <br /> 5_ 'rf FEB ? 2064 <br /> H' .OUNTyt43 <br /> GRAND I$1 A NCBRA DR <br /> DESCRIPTION OF THE MOTOR VEHICLES f <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> MotorVehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural 1 Educational ❑ Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation If multiple use classifications exist: I'YES ONO <br /> 1 e a. `� 1 1 (' ` ` ` If No,give percentage of exempt use <br /> �A1.,�t/!� `�ec�.n� cr1 CYatl tells t i <br /> SA--11 Ork owe dt6ab,\;.a-.i ?r-ogc- - <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 employ nt based on race,color,or national origin. <br /> sign fii 6.440/4.4-- ea—ow -/z/ <br /> here <br /> /Pl!ithorizure Ti tle Date <br /> FOR CC_1NTY TREASURER RECOMMENDATION <br /> Ace- <br /> APPROVAL <br /> RECEIVED <br /> NTS: k'�"--"'� 1 t) 41,5:47 77 �` <br /> ❑ DISAPP ROV,� FEB 2 0 2014 <br /> TREASURERS OFFICTI SI ignature- "of County Treasurer Date <br /> aunt FRRASKA <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> AAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> 0 , Mt- to9s-,y <br /> /Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§]]d02(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-2532006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS, <br />