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TO BE FILED WITH Application for Exemption FORM <br /> YOUR COUNTY from Motor Vehicle Taxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> •Read instructions on reverse side <br /> Applicants Name County Type of Ownership <br /> • C-�cob c LL. TUL�,�Cr1b5rc GRf ik ,(., 1.15 -n)c- apt L L c,Nonprofit <br /> Street or Other Mailing Address aox Q County Number Corporation <br /> City <br /> 1 SOLI S r�y 3L.r : n aox ■Z ta�p Cotle State Where Incorporated <br /> ❑Other(specify): <br /> Identify Officers,Directors,or Partners <br /> The - Name,Address.City,State,Zip Code <br /> Psa A-rn €u{s b <br /> LIST SPECIFIC DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach additional sheet if necessary <br /> Registration Date or Date <br /> Vehicle Make Model Year Body type Vehicle Identification Number of Acquisition if Newly <br /> VII - ;,.�. , ___ <br /> ,NN', Purchased <br /> . fir - yL��!�.��c� curMl'Jl 1 �_ �.u�� •eallA���.:i.J <br /> YVII•u_s E-,sn.a--i ciSeraI tei>,_aee:mtaaa∎TflW�ltTaIt a Fl:'a'/11I1L1,ia•': 30 1 (at <br /> rvg.VRo..."T aooct MPA\a .9C,twrs-R6cgt3ta).tc® rR,strZjety lIbA%olt <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used _ 1 <br /> ❑AgriculturayHorticultrai g Educational E]Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Give detailed description of use,including an explanation if multiple classifications exist 7g[ YES ❑ND <br /> .,w taw •tC.k &es • t.\. •A fit ' • a.: ,__t..?.:. <br /> If No,give percentage; % <br /> Under penalties of law,I declare that I have examined this application and,to the best of my knowledge and belief,it is correct and <br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization owning said property does not <br /> discriminate in membership or employment based on race,color,or national origin. <br /> Sign adPS� D to Ay <br /> _here Authorized Bigna re rile Date <br /> RECEIVEDFOR,COUNTY TREASURER'S RECOMMENDATION <br /> (APPROVAL COMMENTS: <br /> Y y.rS77 ®aZ� <br /> J,:N 1 1 2014 <br /> ❑DISAP IIROVAL <br /> HALL COUNTY '7/® r/I 4a --��/� <br /> TREASURERS OFFICE V Signature of County Treasurer Date <br /> BRaNOJ LAND <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> JPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> ��y�T/�(�� 1K` G/7/y <br /> • /Auihonze store Date <br /> Nebraska Department of Revenue Authorized by Nett Rev.Stac 477-2020 X00)004185§60-3.189 <br /> 96-253-2006 Rev.5-2009 Supersedes 96-253-2006 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />