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TO BE FILED WITH Application for Exemption <br /> YOUR COUNTY front Motor Taxes FORM <br /> TREASURER by Qualifying Nonprofit Organizations <br /> Read instructions onteverse side. <br /> Applicant's Name County Type ot..ne <br /> C cobkot LL- IssM Syesrc%ata k Rpt` A T0C, apt L L <br /> Street <br /> or Mating Address County Number Corporation <br /> 180t4 S £dd 1 St-. P n aO)c 18103 <br /> City I State Zen Code State YVhere Incorporated ❑Other(s(>w.i1YJ <br /> v�N.6 rs\AwU K32- Lo8soa N <br /> Idenfify Officers,Directors,or Partners <br /> Title Name,Address,City.State,rip Code <br /> Hi . /trcc(kaKt> <br /> LIST SPECIFIC DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach additional sheet If necessary <br /> �I yy� Vehicle Make MadeSYear Body Type Vehude Iden n Numb R >�r or Date <br /> INS °'_�`�-_i 1s� �.•ev .e.e�wlr[_.'A'-i a nine ` ..K IIi..'y a�;Zen f.. <br /> R- L�IIr•%faar� , Wit; _�ra;,:ii7 'IC � <br /> --- � mil5-Z-S•liFT:Im- e•- �O (at <br /> r‘+rcA/Pa%I" aoo9 ScnCMp, iwr5'7+<xg13121ts 7--.r.:....-' , n n►uf:�.t <br /> Nature of Wee(Motor Vehicle: p� Ate the ldcles aced/ <br /> ❑Agriculturat?Wrtiwllural Y>v Educational ❑Religious ❑Charitable ❑Cemetery exclusivity earn east? <br /> e <br /> Give detailed description of use,inducing an explanation dnnWGple classifications exist g <br /> Y66 ❑NO <br /> Ltd tckt - t <br /> PIr; Mme r ltenk� ryc- t <br /> SA S . ., J _ ,... .ar . ` If sb:9lve peraenoege: .. tae <br /> tinder penalties of law,I declare that I have examined this application S all,to the best of my knowledge and belief,it is and and <br /> complete.l also declare than=em daleauthhorbted to sign this exemption application,and that the organization owning said propdrty does not <br /> discriminate in members hip or employment based on race,color,or national origin. <br /> sign <br /> here► t.° e i, p 64 i <br /> RECEIVED FOR.COUNTY TREASURER'S RECOMMENDATION f• / it72e,,2-,f //PROVAL COMMENTS: C •" SsEC /19-'1-, A * - • ' <br /> JUN 1 1 2014 <br /> ❑DISAPPROVAL <br /> HALL COUNTY t ��TREASURERS ol Treasurer GRAND JS RE NF <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> 'PPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> ."_, 1/Wre r /7/� <br /> ed <br /> Nebraska Oeperunent of Revenue <br /> Authorized by Neb Rev.Star.§77202(1HWfdl,8803.185§9!43.139 <br /> 9253-2003 Rev.5-2009 Supersedes 98.253.2006 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />