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<br /> 111,...-1 -_ _ 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 /> Applicants Name Type of Ownership
<br /> YMCA gi Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 221 E SOUTH FRONT ST HALL Ei Other(specify):
<br /> City State Zip Code Stale Where Incorporated
<br /> GRAND ISLAND NE 68801 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br />•
<br /> The / Name,Address,City,State,bp Code
<br /> A.r_ / ' sr,' : - - Ae e-/S ` eat ,,/ ► , u. „/ seer- ,/ Aire. .8'0
<br /> FirtL�� ! Ct_ _ ___ -.__,,_ ILIff ,..�_^ Wit/ a,
<br /> mem Mt A_ ainIM''1011210� ,lt ► Ng a/
<br /> r DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,It necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make ModelVear BodyType Vehicle ID Number Date of Acquisition,
<br /> ,� y` if New Purchased
<br /> of j99a. all if 3532 781 ^9111%
<br /> Exempt Uses of Motor Vehicle: ���,�f///'''��� Are the motor vehicles used exclusively
<br /> 0 AgriculturavHoracultural D Educational 0 Religious "Charitable 0 Cemetery Are th sated?
<br /> as Give detailed description of use,including an explanation if multiple use classifications exist: $YES 0 NO
<br /> 1�0 L.,41,1.1 qv-, eeK�(`fsq)( ! /(Ltd��..� -j(,t �w.�o If No,give percentage of exempt use:
<br /> i CIA{ l� ri0 n2pfr S caa eta, . r city J G� siverOG ow-
<br /> „,
<br /> w- %
<br /> non's y7- CCticw a Mis-5tort_ ,
<br /> GI 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!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. n
<br /> sign _ _ &4s,:'t°ss di`re /1-10-/y
<br /> here Authorized Signature Title Date
<br /> ,,,,,,..,, FOR COUNTY TREASURER RECOMMENDATION
<br /> ITAYPROVAL RECEIVED COMMENTS: F-- — _voE- ,,azN ...t)vs"s 77_Jez,,'
<br /> ❑DISAPPRCVAL
<br /> NOV 1 3 2014 cYfaa,de- /-9_, /45—
<br /> • Signature Treasurer Dale
<br /> HALL COUNTY FOR COUIITY BOARD OF EQUALIZATION USE ONLY
<br /> I rcEASURERa OFFn.E
<br /> 1 GRAND ISLAND,NEBRASKA
<br /> 'S[ APPROVAL COMMENTS:
<br /> LI DISAPPROVAL
<br /> [ onzed Sigar ure ft Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat§§77-202(1)(c)and(d)•and 60-3,185.and 603,189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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