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gi %fl 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 , of Ownership <br /> ((1 l- <br /> e. l <br /> �. t l a . _ 11 a. r -i ' A $ - , IS Nonprofit <br /> -et or Other Mailing Address, 1 ] 'p � Q r County (� ` Corporation <br />• <br /> Soo LOQk..l 5L. 1 O. �� ,Ull�� r4 L-� ❑other(specify): <br /> II City \ ) State Zip Code State Where Incorporated <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City.State,Zip Code <br /> YFk PC Afb <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> T r nn ionaL .Qon5 TRAcXOR I1-5y$At4R45 '031 s5 I-'t - o-14 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural ®Educational ❑ Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classiticatioonns^exist: y$YES ❑NO <br /> _&' mow Lr ncLu.\\n3/C0`IGGI.TI� Oc WnA"�Yt " If 7N'o`,give percentage of exempt use: <br /> trite r—t Oti r ca\Sojp l k: ccotgavv.s • to <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 ' Lon-kol - 05-01-04 <br /> here ,Authorized Signature 10" Title Date <br /> • ' OUNTY TREASURER RECOMMENDATION <br /> APPROVAL RECEIVED CO MENTS: '�/'�"n �`� 77- wo- <br /> ❑DISAPPROVAL M Ay 1 2014 — <br /> HALL COUNTY it Signature of County Treasurer Date <br /> I. TREAcURESS-OF,RC. <br /> GRAND ISLAND,NEBRASKROR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> $APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL <br /> I • <br /> f , • __ . -. <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.51st§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 9-253 a 0epanme <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> A <br />