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11-14-14;08: 19AM;CENTRAL NE CHILD ADVOCACY CENT ;308-385-5238 # 2/ 2 <br /> ,— • 901'6 <br /> -- -e-- Application for Exemption FORM <br /> REVENUE from Motor VehicleTaxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with yeureoutdy treasurer. <br /> I •Road IMiruatbne M revaiae tido, <br /> Applbams Name type of Ownership <br /> CENTRAL NEBRASKA CHILD ADVOCACY CENTER ®Nonprol <br /> -Sheet orClher Melling Address County Corporation <br /> 2335 N WEBB RD HALL ❑Other(moony): <br /> City States Lp Coda State where incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Addros6,City,Stab,Zip Code <br /> 4 R• & <br /> oESORIPOoN OF THE MOTOR VEHICLES <br /> •Attach an additional sheet IT necessary. <br /> Registration Date or <br /> MotorVehreb Make MedOIYUer SodyType , Vehicle ID Number Date M Acquisition, <br /> MN Purchased <br /> _. sa�I J'F.ir.7r_^ LA <br /> Exempt Naafi d Motor Vehicle Ate the motor wades Used exduelwry <br /> 0 AgrleuWrallHOrdmlwal ai‘tradonal ❑RerigCus ❑Clutha*. ❑Cemetery as indleatedT <br /> Dive detailed description of use,Including an aplanatlo)n it mWllple use classifications Sate s ` Q455 0 NO <br /> ` se `0 *k e A H-1 iv ji Cotton}l`ts ',V`c irlrletal-t -d,isa trt(I o,give percentage elerempt use: <br /> flaAM yyye-el-i"ss -1 e1.i'ss% uicl-aWtS o-{' oinks-Q. x <br /> Gist 4 r j-ra n .1� 4 i/citawt W� ezL' es 4- 4-10.3-Y lnos <br /> +haruskow.[ s .t,e• <br /> Under penalties of law,I declare that I have examined ells application and mat it la,to Me Bret of my knowledge and belief.true,complete,and coaeel.I <br /> elan declare that I ant duly authorized to sign this exemption applCMbn,and MMIM orgenatbnowning tae ebmrodisted property dens not diealmbtee <br /> In membemhlp or employment based on race,color,or national origin. <br /> sign f [ecctiav-2 Ire /1- /3-1 y <br /> here Au Radium rile Dale <br /> FOR COUNTYTREASURER RECOMMENDATION <br /> ID,AfPROWAL RECEIVED COMroENTS: 6-* - , y-S. *77- o2- <br /> ❑DISAPPROVAL <br /> NOV 1 4 2014 42-ed!ua' /-r=/15 <br /> `scomuro re-- Dab <br /> HALL COUNTY 4OR CO1NTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA. <br /> %APPROVAL COMMENTS: <br /> Q DISAPPROVAL <br /> Its II : I rA /l J- 13—/5 <br /> 5f^odzed-'•n n Data <br /> nebrwie oepartneMo$Mammy Authwaed by Noe.Rse Sim.II n-2020Nc)and(d),arid e04185.end alai <br /> a&28Y2We rue.54011 aww,edw S&2$04005 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. • <br />