Laserfiche WebLink
ev-L---z— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor VehicleTaxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed wall your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name,r , 1',I �-'3f•'. C Type of Ownership <br /> Z Nonprofa <br /> et or Other Mailing Address / qq County / Corporation <br /> 2 5 3G. Carle.1 su. k V r_- h1 ..1 ( ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br />• Geto_vAei i s(0-,,.el N E 6 no o 3 /OE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> GLal . Inn a -hAts4A Kk,>n Pc Bx L34 6460n. .tJ£ 6151o4 <br /> Vice C.l.ct ii- vv.e—,n Arnofcl Clitoris) 3867 RJ R Ne.✓.5oh, NE G 8q ` 1 <br /> Sec /Tr ee.54re� flaw eta.[( 20/7 A 3 't O A ,0E 6 876 1- <br /> r_ 6 6 Vic-,nc (1 a-un p6e.Ii 214 4) Denuer It Still-5, NI 6 87:41 <br />• <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> i301.cJa a6 ( 3 4ir Gj3fr. AC4 flOGCG,SORSan17 734y/ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural Ell Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation s explanation if multiple use classifications exist: [RYES Ell NO <br /> 'Ti T F^aM s e c.ct de D a b tit Lev i tC tt y 2 i S 0-10 �t e( If No,give percentage of exempt use: <br /> • ihet :U, c, t.L/- JS 0.. A QbroLitkde, Services % <br /> c °LMp104 h'y`�wit, <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 APP-t ; o he L.-let-v-1 Arta bir-Pcfvr sc.! (14 <br /> here ,Authorized Signature Title Date <br /> ■ <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> WIfiSV2lf�3N ibNVTSI ONVLS <br /> _/ aoito saaansvaas ,, .} ,J i0`77 4.7C 2 <br /> I�APPROVAL AINROQTIVli COMMENTS: <br /> ❑DISAPPROVJ L <br /> 4V4$IOT 5 - 7 <br /> dS <br /> iii 9-s-/V. <br /> A•�-� • Signature of County Treasurer Date <br /> as A' J s� 1 FOR COUP TY BOARD OF EQUALIZATION USE ONLY I <br />• <br /> gAPPROVAL /' VV COMMENTS: <br /> ❑DISAPPROVAL <br /> gigkiljii <br /> 0 ■ Authorized Signature Da <br /> 96-253-2 Department Rev. -2 d Revenue Adaodma by Neb.Rev.Stat.§§77-202(1)(c)and(tl},and 80.3,185,and 80.3.188 <br /> 96253-2008 Rey.8-2011 Supersedes 96-253-2088 Rey.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />