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.e.,_-L, 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 /> Applicant's Name (( —�• C1 Type of Ownership <br /> C-xnodWtl‘ \ ry: t om"] Li `Ire 1V.e,L1io-4?c - ,-ct $Nonprofit <br /> Street or Other Mailing Address�, 11 ^per,) •� Q / 2 County (� Corporation <br /> t 204 S. f OA�.� � .. 1 . fl. �X ` i n3 A4,1-1-- 0 Other(specify): <br /> City \ State Zip Code State Where Incorporated <br /> (,ERnd _i_: :1p,,K)t Nie_ Lac)%o- N2-- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Yr }r k PcctPL4cf t7 <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 /> if Newly Purchased <br /> rrn*iaNaL QOn TRACTOR lk $,$45'881=155 it-3o-1s4 <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 toff use,including an explanation if multiple use classifications exist: 1 YES ❑NO <br /> `A � [lal-A` n`�/cctkC.CA-tin oC dona-CloNS -k't'1Gu IfJ No,,give percentage of exempt use: <br /> SLt.,Qfprt Our c!VSOt1.h c'or'd V\s . r <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.l <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 17 ConA-rolhtAr- o5-o1-r4 <br /> here I Authorized Signature / / Title Date <br /> _ s OUNTY TREASURER RECOMMENDATION <br /> APPROVAL RECEIVED CO MENTS: cs i" Ala:ek a.77- Q4e9 cz-- <br /> 0 DISAPPROVAL MAY 1 2014 — <br /> HALL COUNTY ■ Signature of County Treasurer Date <br /> TREASURERS OFFI E <br /> GRAND ISLAND,NEBRASICROR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> o DISAPPROVAL -; <br /> 6/ h `�=�� 6#41.i f <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 />