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• <br /> e " Z— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 457 <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> JJ pp <br /> b -r 'I- n .- .- Dd -it L: J , n Nonprofit <br />' Street or Other Mailing Address County Corporation <br />• 33 �V' Oaf): � /} e E J 4l & ( I <br /> ❑Other(specify): <br />• <br /> City State Zip Code State Where Incorporated <br /> C� r&ret �land, NE ),t C_ <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> PrPc,dcrti / ets , T'n, Kolb Lyn -e. St -n',.nisl;nf 'LIE �C .3� <br /> set(kt'ury in . la, C,reenwaAi Irjp1 el:tier st 44t)ldr40 Y e 1 LiE /of iie <br /> irvtrd 1'e-f-( K;rau 31y u. Al: n't,n aut. /I1:n4.en if r$ei Se <br /> jirare' ill tub-eon Nunfar) '53 ti F. di; I: Jetty Ilea 1=r=P rnratl Mel G,SL&,S <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 /> e-hPJ1 l/1'l.OrclG L5 .,00s N-door sea a2. ,a &J A4 55k 555,.731 44/, 1 /)5 <br /> -17; net rawrus 5 6 2bo-7 LE-doorSPctar frAFi531.Lx7al /n�/5D %IS <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> as indicated?Agricultural/Horticultural 12WIticational ❑Rel i Religious ❑Charitable ❑Cemete Cemetery <br /> Give detailed description of use,including an explanation it multiple use classifications exist �." ONO <br /> A non pro t.y ayerEj 4-r'rC✓t +rbv:des 6- °O-r; e I v� If No,give percentage of exempt use: <br />• <br /> SFrki;Le.s -�o i/nd/:J" ALiaJs I'414- <br /> 5 fin: Cur*k <br /> d s 6. b; 1; ti.es I n ihP, r homes and <br />• <br />• <br /> Cornint-co tL;es ' <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. `' / a <br /> /23J % <br /> here ,Authorize igna' tore Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> PPROIAL RECEIVED COMMENTS: RERE "Se l "III •gliC- - .7 7--acce. <br /> ❑DISAPF ROVAL JAN 2 3 2015 <br /> L°Q ' /- .7.3"S— <br /> HAI I en INTY. ,Signature of County Treasurer Date <br />• <br /> TREASURERS OFFICE OR<OUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND IC D,NEBRACt <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> 7/4 /� / <br /> ' Ar47 15 <br /> t ,: o z-. • : � <br /> Date <br /> Nebraska Department of Revenue Authorized by Nab.Rev.Stab 77-202 1 c an0 <br /> 96-2532006 Rev 8-2011 Supersedes 96-2532006 Rev.5-2009 fi� OO (a7,ad 603,185,and 603,189 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />