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� - <br /> � Z-- 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 /> Applic is Name ^yI Ann ,,�y(', 'n n I I 1 f Ty e of Ownership <br /> ilk L7rec+ l 10,1 n s ! U 1nuaI CO11J e(eI c.t cf-TVA 11j c" i gNonprofit <br /> et or Other Mailing Address / County G h -«a�' Corporation <br /> P c . S bX yryV H T- /__ <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> i. I ro.nd leSlQnd N E to g siaz K015CAs <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Na c, lob a t l . .ad e.cA' k - 6:.3f <br /> ICRIMMIN Comm; 42 . - _ ;. . I <br /> d C� ' .. .rn },M . ✓\ La. /'TJ3 �rs'a . A + ■ ► .•So a <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> // � L if Newly Purchased <br /> ..A • . e` Zoo - (2 ..._ -L ■ L! : ' ' .00eO,• <br /> • <br /> Exempt Uses of Motor Vehicle: I� Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational 1°I Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: .L NES ❑NO <br /> irr'a\v `e.I\ F/0CG nc\ �,ro rn On 22+1 n S i r` e dls\li c1 <br /> ' s uc eAk 0.S ' `0sP ( 1 of sv e, rn v l s 1 It No.give percentage of exempt use: <br /> 'pts-,--rcc\-- c5t-A p€e,ri ntQnctZrck ±ra,Ve.(s cxcCccSS-1-ko— <br /> 5A-01/4.\-.e_ +o cSLkpe.rvi se, Ipo.S-orS ° aSouro r■3 Chv.rclkns <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. l <br /> sign ,1r1� �2c/ l�r 17,51r■�� svin�err�l �-S-��f <br /> here yuth zed Signature �/ Title Date <br /> roily),TREASURER RECOMMENDATION <br /> RECEIVEDMMENl, <br /> /APPROVAL <br /> ❑DISAPPROVAL F r 13 7 2014 <br /> :, •i _ i [ .,d_ .t.. J-zzoiV <br /> IIULLOOUNTV Signature of County Treasur- I gate <br /> T4aAcuOE°S orate_ <br /> GRAND ISLAND.N NTH BOARD OF EQUALIZATION USE ONLY <br /> yc APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL <br /> 6 fare IX' / <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185.and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />