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ist — 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 /> PROPERTY ASSESSMENT •Read instructions on reverse side. <br /> Applicant's Name <br /> Type of Ownership <br /> t 1 MALL4ries J r(2LI-A•- ' &_A-as'•s _Inc, <br /> gi'Nonprofit <br /> Street or Other Mailing Address �,,j, P (� t e�( � County is.c Corporation <br /> t b o4 <S QA P O e 0v t 1 3 t- i'f U.. ❑Other(specify): <br /> City r. y State Zip Code State State Wh re Incorporated <br /> a te� <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZA : , . <br /> Title Name,Address,City,State,Zip Code <br /> P5. $tr rir-1•\t f b Pre <br /> 2014 <br /> 6 I j UUNTyA3 OR <br /> DESCRIPTION OF THE MOTOR VEHICLES N®t N • -v ,. <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 /> if Newly Purchased <br /> ale.t Lt moat Tcc>_: tex- se t u`/y5 a539 tct Ta8ts3 at q/14 <br /> 1t+tltiy__ aooa Tra.tter 53' Iuyvsa53 eRarlSo 4/ig/tLi <br /> Exempt Uses of Motor Vehicle: ,-�( Are the motor vehicles used exclusively <br /> ❑AgriculturaUHorticultural IX Educational ❑ Religious ❑Charitable ❑Cemetery as indicated? <br /> f <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: IYES ❑NO <br /> WE + If No,give percentage of exempt use: <br /> n er 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 /> U d P naW <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 employ nt based on race,color,or national origin. <br /> sign ■ /) ecd -o7h -moo -/� <br /> here thorized Si ture Title Date <br /> OR CCJNTY TREASURER RECOMMENDATION <br /> RECEIVE D� ,� 7� � � <br /> APPROVAL COMME NTS: v""- / <br /> ❑ DISAPPROVk <br /> FEB 20 2014 I <br /> TREASURERCS FILE Signature County Treasurer Date <br /> N <br /> QOGNn' ANO p ASEA ,.._ <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> e <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> - ,I i M` .?as-/V <br /> /Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§71.202(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 />