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,r,272L, • 3g;•S2SO R(t- lof-IO <br /> Ne, ke'De - Application for Exemption FORM <br /> UE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> -- 'ate •Read instructions on reverse side. <br /> OApppplican(t�'s Name ( c Type of Ownership <br /> //Ilf1 Plc/4C Cede, for. belt V,®rr' H4..014 cc.Y Sc,we es c Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> C(5- gill Cfvi Hall ❑Other(specify): <br /> City Slate Code State Where Incorporated <br /> G�nd 14 141 J NE 6880 i <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> CEO n.a &jai trots <br /> Jiro P/ertd.at c,j.`e Ffa'reel l 1103 PAMj(q es( ?nt tow Nei Ali 6fl k7 <br /> 5a (41 So at, J 1Le . <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration.Date or . <br /> Motor Vehicle Make Model Year Rodyrype Vehicle ID Number Date of Acquisition, <br /> if Wrn Purchased <br /> CIcJce GOOI 4101 mM)V.r &844P44351IRa1351N VOA q <br /> Exempt Uses of Motor Vehicle: ' Are the motor vehicles used exclusively <br /> ❑AgricuhuraliHorticultural ❑Educational ❑Religious m Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist ®YES ONO <br /> 4141,00.41 cod J tz.seet s 44-cioni P toy/E nhs/SPcv cP3/c(cSr /'�'•s+4fola' If No,give percentage of exempt use: <br /> O % <br /> • <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 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 /> ' I i+4idicet! <br /> ..6€01t.. 44c 9V1tdi6,ssCcntv-1.r halt.uorv'rlseewwo•sZ•. <br /> sign —a ,iP/bbd <br /> Mere •, th• '.-•Signature sr Title Date <br /> FOR COUNTYTREASURER RECOMMENDATION 4,...,5:4: �/j <br /> [�A PROVAL RECEIVEL�MMEN I' : 6% - , � ' 7 4o. <br /> ❑DISAPPROVAL <br /> 2014 R 7/V <br /> ► <br /> AUG 2 5 �� <br /> S' to o unty Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> 1 <br /> TREASURERS OFFIOE <br /> %A APPROVAL tiRANO ISLAND.NesRgescsoc: <br /> ❑DISAPPROVAL <br /> Authorized Signature Dare/ <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(e)and(d).and 60-3,185,and 50-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96253-2005 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />