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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 /> lAppyl nt's Name . ! A / County ��(//� Typ,,,ee of Ownership <br /> j40D id///// .-1.//6457(11°S n {/? �o(Y/�4rzah, /IV/ ask.£ & Ain a- II TNonprofit <br /> Street Other Malmo dd �nJ7"'. /^• C. ,C�Io l�/U(p�J / O County Numher /JC❑'Other Corporation dY). <br /> te Zip Code�0 4w 5 rs/L Lab / t bill�- State Where Incorporated C , <br /> Identify Officers.Directors,or Partners �/ <br /> Tide Name,Address,City,State,Zip Code <br /> Pa nehlf) <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 /> Purchased <br /> dAQ' oLct ao/3 VnAALR LS al 8/is//471 <br /> ewel/afrr ap/3 Tin/PAi4 L r a&uf/4CE.*{n /s oz P 8/4t/y <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> ❑Agricultural/Horticultural 'Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Give detailed description of use,including an explanation if multiple classifications exist YES ❑NO <br /> n�'' <br /> ('7 0CleY/4,//ft' STn,e, IS ,eashi ess Ifs, An,/ Ong ./O/tiiQ7 ari. If No,give percentage: % <br /> • 177 /Je s -APe L.a0A,'cm-7 . P2 ti.k/e. 2.1..C., p,S / <br /> ,are&ardtie// ot, <br /> oryyls4 . <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 duty 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 �e > 6�O e // <br /> here ► � Tide Date <br /> FOR COUNTY TREASURER'S RECOMMENDATION <br /> 1 PPFOVAL RECEIVED CQMMENTS: a� , "'S s, a'? .70.2.- <br /> ❑DISAF PROVAL <br /> AUG 2 1 2014 ,i4g©-�s� 8=-7a-74' <br /> ►Signature of County Treasurer Date <br /> HAW rrfUarry FOR-COUNTY BOARD OF EQUALIZATION USE ONLY <br /> 'TREASURERS OFFICE <br /> GRAND ISLAND.NaFUZASISA <br /> APPROVAL i.OMMENTS: <br /> ❑DISAPPROVAL /�z��� ✓yQ <br /> ►AUt man ( Date'074'/y <br /> •Nebraska Department of Revenue Audhodmd by Neb.Rev.Stat.§77-2020ao)Id),560-3185§60-3•189 <br /> 96-253-2006 Rev.5-2009 Supersedes 96253-2006 Rev.t 1-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />