Laserfiche WebLink
wven--Z-- Application for Exemption FORM <br /> Nebraska Department of <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 /> CENTRAL NEBRASKA HUMANE SOCIETY ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1312 SKY PARK RD HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE • <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> T.e ,. e,Addre - dg State, pC••- , a s-.- <br /> �1f 'G <br /> ..�i n nu SM OIS r 0 a i' '_AWJAY� <br /> s_ Cl Ar.Ftiter ..pia - YI _ it4 IFS -6/ <br /> 7► Y _ A trG e Fi72W LIIMME <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make 1 Model Year BodyType <br /> I <br /> f Registration Date or <br /> Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> • wallyera.o WFYla Tr3L 1 . s ` : I. Ore-49110 <br /> t I5b . Z . sM�7.7fl! a1 = V0 = • <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusrve(y <br /> El AgriculturalMorticultural ED Educational El Religious ET/Charitable ❑Cemetery as indicated? <br /> Give detail••description of use,including an explanation if m ltiple u act- . ' ido-exist: , /ES ❑NO <br /> / ///(�y//� r i /. <br /> s1 7 y/ .,fj//., 7° • ` i /If No,give percentage of exempt use: <br /> ti ri _ , � -', , �o Of <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 dedare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in members,i�•r employment based• race,color,or national origin. 4 <br /> g �' � ! ,, . n, //409//4 <br /> sign II _ �f �t� ` �A !:.' . <br /> here ' thori ed Signature Or / ` Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION J <br /> APPROVAL GOMMENTS: '•'��11eaj A 1 5'5• ?71 ac <br /> ❑DISAPPROVAL RECEIVED <br /> / >>fi�(�� -.O a <br /> -/C <br /> NOV242014 Signature Treasurer <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY I <br /> HALL COUNTY <br /> APPROVAL TREASURERS OFFICE CON MENTS: <br /> GRAND ISLAND NEBRASKA <br /> ❑DISAPPROVAL <br /> area' /-/3---/ <br /> 5 <br /> Au. on IV 'gn Mir -L Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat-§§77-202(1)(e)and(d).and 603,185,and 60-3,199 <br /> 96-253-2009 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />