Laserfiche WebLink
a- L--e-- Application for Exemption FORM <br /> Nabraak&epartment 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 /> Applicants Name ff__ Type of Ownership <br /> IP m;J GV <br /> ,o1 :45 Cen(er s-or tiau>ara( Res((f(1 C'Cf. 5or✓ycpx71,/G Nonprofit <br /> Street or Other Mailing Address 3 County Corporation <br /> 61 5 E 1 vIi + Pc, 6e.`i 1 /-7 /6 l tic I�r ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> G(Kr,el i:,lanof tic 6 f'e'oa 4/c <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Pt95 :rieid °L'fd c ri,,-e£',., -.-ris Ho.5.-- 5“.e rf vtIt - /JC w kri,:ve7 /t'F (�.ct y� <br /> 5 q Ustlt''-RJ AV <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 /> Omly �.¢iG JCn _adSOed- , UchSfG'f 904AP Loos jR�`l ki 74 ! cit/eq <br /> • <br /> J i <br /> I , <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if muNple use classifications exist t f YES ❑NO <br /> 1L,., k/cn s u-C'c( 10 4-cc,r7(t4 C�'e-•ti"� 4-r - -ir5,o1 Sti✓,��5 If No,give percentage of exempt use: <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 appli£anon,and that the organization owning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or natio . orlpin. <br /> sign _ 2 (4)// « /v /y <br /> here ,Authorized Signature Title Dare <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> le APPROV-L RECEIVED CO. ENTS: �"X' daft-w—, , S ?7- ac a. <br /> ❑DISAPPROVAL MAY 1 9 2014 <br /> r9 ���°-e' , -dip-may <br /> HAI I Cfft mint <br /> Or Signature of County Treasurer Date <br /> TREASURER_S OFFICE FOR •UNTY BOARD OF EQUALIZATION USE ONLY <br /> . <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / /3)-6 �n `� ahv <br /> Authorized Signature Da e <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)1c)end(d),end 60-3,185,and 60-3,185 <br /> 96253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />