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men----e Application for Exemption FORM
<br /> Nebraska Department of
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be filed with•Red instructionyour n reverse side.
<br /> Applicant's Name Type of Ownership
<br /> ORPHAN GRAIN TRAIN
<br /> ® Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 427 N SHADY BEND 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 /> Title Name,Address,City,State,Zip Code
<br /> 49AaM'iyfy 1;11%/1/4 &l? 6fr&'( w f 6"C'1/4', yrcJTA-a-'oacu 40; �'RRrvi3ff ma), Na 6eSoi
<br /> /�Z.s`` d" ,t i erg 4noer,j Qe.4ie, /90 39",1-ve, ileo.r ity rya E83�s
<br /> 5 eere hr,7F'' nn yugt-da'!�R. 580 rV Lthjtgoe Sr/I&ve mite., iVS (9780
<br /> e-4-54.trer .'1--I't £tea-R K , 86)4 v57 Sni-41ya3,A/$ /8q.S,f
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,it necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make I Msde!Year Body Type Vehicle ID Number Date at Acquisition,
<br /> it Newly Purchased
<br /> co AD r350 2 crs7 ftcWV? 1ff5G13e5624:e995i7
<br /> /7hc4Lcb✓ry 4$12 do 10 'rr/141- IR 4-9(Sr ies"tor 5,11 f g a
<br /> tibak t ter (7Xr6 ,t072 rrMi-er SS BTol6aye40e <F.23b
<br /> Y1rA,G o Re,,,,I c- ' CV/ 1195 ,4t4nw /4sane -.26 8XG 3i4 6': O/A-GOO
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricultural/Horticultural ❑Educational ❑Religious NrCharitable iii Cemetery as indicated?
<br /> Give detailed description of use,including an explanation it multiple use classifications exist pi YES ❑NO
<br /> telti) ier � n9-.,sr'tic? lit cd-tui-I--te.,S. 94y,1ir✓; rchei 2 Lerns
<br /> }n.4 6o,traz echo`e c F"L Ac'1.4 ' / in, eq iCal. If No.give percentage of exempt use:
<br /> S`f�PGleh /ati44 /{oveeh.°l 1 Co'de S 2 A C'er-+rml-- Ne, %
<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 l 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.
<br /> sign 407 �)r�- 49rn0,-417i4e r e pe A `F here 'P hat The Date
<br /> I FOR COUNTY TREASURER RECOMMENDATION "/, �i 1
<br /> [ APP AL RECEIVED C�IaIMENTS: � s St- #��w ��K
<br /> ❑DISAP ROYAL
<br /> NOV 2 4 2014 6 40-x' bi ' /-9—/.�
<br /> Signature of unty Treasurer Date
<br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> HALL J TREASURERS OFFICE
<br /> Y�APPR GRAND ISLAND,NEBRASKA COMMENTS:
<br /> ❑DISAPPROVAL
<br /> �% e/1/ /—/ 3 -2(
<br /> ,horized_ignature
<br /> - Dale
<br /> Nebraska Department of Revenue • Authorized by Neb.Rev.Sat.*5 77-202(1)(e)and(d),and 60-8,165,and 60-3.189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-2592006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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