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TO BE FILED WITH Application for Exemption FORM <br /> YOUR COUNTY from.MotorVehicleTazes <br /> TREASURER -_ Qualifying Nonprofit Organizations 457 <br /> .ftead instructions on reverse side.. <br /> ATName County Type of Ownership <br /> Y/th// eindasines t /,w r' /&sk.Tt /i 4L- ortproa, <br /> 4141S.9 d �� Number Corporation <br /> . f/d &v/S:3 bi ❑ (specify):): <br /> 449/0h fs IA) a lkep- <br /> Idenfy Officers,Directors,or Partners <br /> rue dame,Address,City,State,Zip Cede <br /> LIST SPECIFIC DESCRIPTION.OFTHE MOTORYEldICLES <br /> •Attach additional sheet If necessary <br /> Registration Date or Date <br /> Vehicle Make M o d e l Year Body Type, .Vehicle.I a e n 6 t t t M n N u m b e r f $ Newly <br /> nifNew <br /> eanoz a?0/3 t &iAQILA LS &4/h'c513:YD noS31 8/is/i <br /> ewe rhltr 014/3 SrnM.4M LT I.4r'/44fly b Lane/a, 8//5/'19 <br /> Nature of Used Motor Vetude:. - Are the metro ee) es used <br /> ❑Agriculturatuforticuttutal 'Educational ❑Religious ❑Charitable ❑Cemetery excl11tivety as rncTeama7 <br /> GiWee detailed description of use,including an explanation d multiple classifications exist $1 vEs ❑NO <br /> ('7'(�1-✓. ;i/ �5'Tp.� ''s 4 s,ness. I c 'on, o,t . �n�12 IMO gi•e-P % <br /> /ley-f5{'iCe LQ('Afl . P'A/. /,e 21S.1 pl'sti r-/ <br /> _under peewee of taw,I declare that I have examined ails application and,to the best of my knowledge and beset,it is=zest and <br /> complete.I also declare that i am duyauthonzed to sign this exempdonappgwtion,and that the organizadon owning said property does not <br /> discriminate in membership or employment based on race,color,or national origin. <br /> sign CEO o/a, /i ./ <br /> here ►AW4,,,,,v&i__ Title Date <br /> FOR COUNTY TREASURER'S RECOMMENDATION <br /> AL RECEIVED 'MMENT& 4?5 "77 ..7oz- <br /> ❑DISA'PROVAL <br /> AUG 2 1 2014 S1© 8= ��-tr <br /> ►Signature of County Treasurer Date <br /> _ •. _.�• FO' •UNTY BOARD OF EQUALIZATION USE ONLY <br /> ASU-^RS • FM.E <br /> GRAND IS D E <br /> 11.APPROVAL re MMENTS: <br /> ❑DISAPPROVAL <br /> ► ` � a� /y Authorized Signature <br /> Nebraska Department of Revenue ANMrized by Net.Rev.Scat.gn,202t1HOWM6O4.1d5§603,119 <br /> 96-253-2006 Res 5-2009 Supersedes 96-253-2006 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />