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NsbCDepa ntof Application for Exemption FORM
<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 /> Appef p nts Name c J Type of Ownership
<br /> ( c 11tSil -e L �) I c•
<br /> A Nonprofit
<br /> Street Other Meili�Rj.ddre s (� ,,, Cou Corporation
<br /> Sk 9\13 "• �661.9 L�- 1• ��X ��U0 7-iLki i 0 Other(specify):
<br /> COY-, St t Zi Code Stale Whey Incorporated
<br /> udi is 1SIcuncA �� G0�S0d,
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Tide Na Address,Ciry,S te,Zip Code
<br /> ( Oa-Y (41 Cu r A lei, Pig I A.,+'r,1 '-talc) Mahe eel CG i N to S i")0.-j
<br /> Vice Pair t 3 A � wen 7 t+ i4.b) Erik _a-t X36- be o-1
<br /> 'reaAuur ,Y ni kw Ili�� Q o Urcuice. y N - 1p&so1
<br /> `See etari bnnlc_ bQJCinrltin eoLf LA) i S (' y, %ia ir; > ;ol
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,it necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make Model Year aodyType Vehicle ID Number Date of Acquisition,
<br /> if Newly Purchased
<br /> 11omeYY24e Icrai \er- aooi riAt he i ioa0001-b? aoNha
<br /> it\urn - 1,-1vie R' ' 3 c2e
<br /> nrTYztller 1 Al0F5inl'&We2.'+Jip2.
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> 0 AgriculturaVHorticultural 0 Educational ❑Religious Charitable ❑Cemetery as indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: ' OYES DUO
<br /> `/ 14 . + . ., .� K n n�? i (do vi t,,/� 24 _ �.i. If No,give percentage of exempt use:
<br /> N.
<br /> GL.t-m--emu kft r N,e ir,
<br /> r,;1 pfr7)- '
<br /> a ' °'ip`t Lu ith.244 of,c.i L12 , /48 b)ma, m aaow
<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 th I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate
<br /> in in rs '•0r employrpent on race,color,or national origin.
<br /> sign / ,c „ i idL w��t FRCP. Did i�a 't/l'+
<br /> here Authorized Signature Title Oat
<br /> RECEIVEDFOR COUNTY TREASURER RECOMMENDATION,t
<br /> B APPROVAL .y a .�l COMM:NTS: ot"'�^' �°z-'A " 5,451 77-..7°,.2a
<br /> DISAPPROVAL JA 2 4 Z013 _,
<br /> HALL �c�-� /- 'r'-'r
<br /> TREASURERS et /Signat�nty Treasurer Date
<br /> ...... ARAM,ICI AN71, R
<br /> NFRACKA
<br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> •
<br /> APPROVAL COMMENTS:
<br /> DISAPPROVAL
<br /> k i /ri c Q /role? !'V
<br /> •Authorized Signature Date
<br /> Nebraska Deponent of Revenue Authorized by Neb.Rev.Stal.§§77-202(1)(c)and(d).said 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.
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