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261 <br /> war 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 r 7 *try of Ownership <br /> S,s lC✓S e- r4r ttlt1-1 t2+1 OP /r try Nonprofit <br /> Street or Other Mailing Address (� t County ` Corporation <br /> 7 20 cis.n.0 son, J4it . MhWi ❑Other(specify): <br /> City n �1 State Zip Code State Where Incorporated <br /> GM,/ a[ ad uC 62gn FIE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title q Name,Address,City,State,Zip Code <br /> S,stco- _ Gan slorn L art Yrr-s.Kt Zr 170,6 313 E. rt.e-n Rd. U).iL M.craa (gyp I/I„co <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 Dale of Acquisition, <br /> pp rr�� (r�z pp if Newly Purchased <br /> d»1A £t'o7 4IF/o-cr Jec1.Rry f PIGrAJG5 .27L13P'E se <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHonicultural 0 Educational 0 Religious ®Charitable ❑Cemetery as indicated? <br /> • <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> T.�.t O,w�r,e+ +u � it�/ ,tsrcru.a-Ar'-C <br /> 9Co-.n,F..rr.GV�r+ ,7, � itA.,..- ;,(,..., �.--•-cJ If No,give percentage of exempt use: <br /> oti <br /> ,MZ,<e�i'W QK + <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. j�/ <br /> sign LC, . ✓ r a! N.lu) . �„ ,}i .• c w � N',lox"20 Lit <br /> here I Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION''// <br /> ©-APPROVAL RECEIVED COMMENTS: •fin �-UJ /v.5S x' 77. Re <br /> ❑DISAPPROVAL _, <br /> DEC 2 2014 �S/"-e�y��[p�, c Q�,,2_ �s- <br /> ► Signature of County Treasurer Date <br /> TRCHHALL COUNTY Orr FOR CO JNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> 0 DISAPPROVAL / <br /> its r/. /-/3-IS <br /> A °orized Signal re • Date <br /> Nebraska Department of Revenue Authorized by Nee.Rev.Slat.§§77-202(1)(e)end(d),and 60-3.165,and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />