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• <br /> Nebraska De`Department of Application for Exemption FORM <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 /' 1 Type of Ownership <br /> ?{e10 sKG DtsCR;LA Co c \ (4 tint ASSN tN.bikcs o4 (908. <br /> Street or Other Mailing Address Conprofit <br /> 9 County Corporation <br /> 1563 W. , ..d Si Pb 3ox nlpc Ei c4J/ <br /> ❑Other(specify): <br /> City Slate Zip Code Stale Where Incorporated <br /> G RASA-a. 2sc.r..d N E (og Rv a AJE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> S rpen;..{c."d,,, -t Rabe k ikkAe. 3o7 6_ sm' Sin-e-e Pt. Ke-coLvtey NE Cv$C 97 _ <br /> Ass•+-•~-t Suitt;n}c...ee.-4 GGA=y Noy t 6-7 0°1 n„ beAR ,tic be.- Pc'p Ilio.. NE 621 3 <br /> SCCbta.+wzy./'f Ra._s vz e. • TgAa4.l p,KO IA-) v,. 64S ) Po KslcV e. L.Anc -Lincoln. NE (cg5o'f <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 /> Toys-k- S:esk%Ws aoty FIAb 2 ?cssevv 5rpKK3DCBESSa a/aim/it-I <br /> 4-13o.2 <br /> Exempt Uses of Motor Vehicle: �/ Are the motor vehicles used exclusively <br /> ❑AgriculturaWlortkultural ❑Educational l](I Religious ❑Charitable ❑Cemetery as noted? <br /> Give detailed description of use,including an explanation if multiple use classifications exist RYES ❑NO <br /> i'k;5 vek,cic wtlk kt idscd 4o 9t..ec. >.-si-cic1 cc_44_ 4o Ot. R ///������� <br /> If No,give percentage of exempt use: <br /> tAkbLt flyer. ao c(.I,M-I..t6 i.” Ne_Lte,s Kg. ut,d wt.aA.c tlt4H <br /> aso c&edc»-1 olcJ N -kkec air - m,n'sk-tits - ?+ tu'll atst, <br /> toe uscd -4-0 ctotd 2,.,,{{ O f- 1>1c-i2:a- c .,-t• 4s, CG.w-,C <br /> • C6AV2nt;0,ns i Sevv.1..A(..A t e.. -c. <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•:.-.on race,color,or national origin, <br /> sign - r __ �= _ - 9 'IKL 1 •f -�(4 <br /> here Authorized Signature Title 4.L <br /> "MD rnUNTY TREASURER RECOMMENDATION <br /> Af ` �7 <br /> Er PPROVAL RECEIVED COMM ENTS: ./' —M° /1124-4--" �' ' 4 • ' -7 ao p <br /> ❑DISAPPRO/AL OCT 1 6 2014 <br /> �_P_GP�Z 40-/c —/7' <br /> HALL COUNTY •Signature Treasurer Date <br /> TREASURERS Or <br /> GRAND ISLAND,NEBFNIPACOL,,ITY BOARD OF EQUALIZATION USE ONLY <br /> p4PPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> �(- 0 r� <br /> /Authorized Signature ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stab§§77-202(l)(c)and(d),and 60-3.185.and 60-3,,89 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />