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9ND 15 <br /> ....n.---e— Application for Exemption FORM <br /> Nebraska Department at <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 Type of Ownership <br /> CENTER FOR INDEPENDENT LIVING in Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3335 I t Cap:W fide . & o3 HALL ❑Other(specify): <br /> City State Zip Code State where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Pie 5. deat rt>r. Kolb /r20, "O" St, c- 04fl:n1 NE Eu193ri <br /> j«retary to 1u, CreernAiaN /00/ /Miler SE-. ttfildr4ye, t4I & $ 2Q' <br /> tl ;cp 'PIP : Lidrnt --re(‘ Knit/ 3i9 A.J. rn;ttripn 'Sue . Ms'nd-en, N Core/ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> I Registration Date or <br /> Motor Vehicle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br />• <br /> If Newly Purchased <br /> r()rd Tauras 200'7 •-t -door 504@n 3 FflFf FP 0EO53 <br /> cileo y f-ropeJa. , DOh a G 3.t.0 to 'S k 55907 3 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 111 Agricultural/Horticultural Educational ❑Religious ❑Charitable ❑cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: .[wES ❑NO <br /> �'� non pro-( -t LCy£ncj 4-h al pV(�11 t des Cl UO-V i E- �`y M No.give percentage of exempt use: <br /> OA 5er0 ∎LeS - t ina2J ; dL.-c !3 U-)'' 4'ti 51'yv� rf,' ca,Ul % <br /> aISG 6: I , -L;es j ; J ; n in the ,* hornes and <br /> 00 rnan tin:: E:e 3 . <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 />• <br /> Sign ,. 7 <br /> here Au1 onzed Signature Tiffe Date <br /> FOR COUNTY TREASURER RECOMMENDATION i <br /> PAPPROVA& RECEIVED COMME NTS: /a-e-c) '`f S. 77- Q"'� <br /> ❑DISAPPROVAL <br /> Nov 2 0 2014 ‘29911, 447.--e-at-le <br /> Signature u Treasurer <br /> Date <br /> MALL R COUNTY BOARD OF EQUALIZATION USE ONLY <br /> NDS OF <br /> TREASURERS OFFIf <br /> GRAND ISLAND,NEBRASKA <br /> .APPROVAL COMMENTS: <br /> ❑DISAPPROVAL +�• <br /> /i �I �L _ /1/-3 �5 <br /> Peened •n, " Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§4 77-202(1)(c)and(d),and 583,196,and 003.189 <br /> 96453-2005 Rev.6-2011 Supersedes 98-253-2005 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />