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en----z-- Application for Exemption Al, FORM <br /> NNab-ask°Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with•Read instructions on reverse side <br /> Applicant's Name Type of Ownership <br /> CRISIS CENTER INC <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2251 N WEBB RD PO BOX 5885 HALL 1 Other(speedy): <br /> City Stale Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> G MLNU [iF 0.l r l.'[ gelEL�T.IN` MTAII ` %WMIS <br /> IfI[J3ETi7SITTA TT'll0'.111MCIEWAI .7 A Ye. to twqrrmasorges <br /> NY-/ UXe/r llnIu7i71 d1TAN!pg fl?Stattr r e f S_i eWM t tIB..Ih.D <br /> R eer- a��t1reMME f .LiiMinifi�nar i tar i i nf►afro ail <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,It necessary. <br /> 1 I I I Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> -V • let aoo Ve itur��err-��Val Mani D%O �wsoa93o`n <br /> -..4. -4 1ialra 4r/u[a�ll!Ittia•YiI, QI 2Yilw2 ae z.saa f r-rr <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 0 Agricultural/Horticultural 0 Educational 0 Religious 'Chartable [1 Cemetery as indicated? <br /> Gi detailed ddeesc�riptio/n�,tfoffuusee,including an explanation it multiple�use <br /> /fclassifications <br /> s�exist: ����� 7L_/��L) ,EYES ONO <br /> VN""CCU/ ( _`' CAted v ` Ci 'litt • '- , p r^ taLt al If No,give percentage of exempt use: <br /> rewte, p iilij I,C ' /, i ®7t (tit ow 6tiG�2 <br /> Cep&e,� aA 1 'apt c .t� oda tree b6 <br /> 4A cc , 3�8- 3ea- 8a5o <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 lam 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 /> sign Sat I A Cyeetth'c JPire,e1-or tl /r i,J* <br /> here Authonz • ignature Tele Date <br /> I FOR COUNTY TREE.A�S�U�REERRrRECOMMENNjD�ATITIIOON <br /> [ PPROVAL RECEIVED COMMENTS: .���`^" - /-- err-2 & <br /> DISAPPROVAL NOV 3 2014 <br /> 4 �-4 /-e-P- / <br /> /Signature of u Treasurer Date <br /> TREASURERS OFFICEFOR CO JNTY BOARD OF EQUALIZATION USE ONLY <br /> GKANU ISLAND,NI;BRASPA <br />• MJ APPROVAL COMMENTS: <br /> 0 DISAPPROVAL <br /> 672 V/Spral. Pal ti3-75 <br /> prized ig -cure Date <br /> Nebraska Department of Revenue Authorized by Net Rev.Stat.§§77-202(1)(c)end fdi,arid 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 98253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />