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TO BE FILED WTI Application for Exemption FORM <br /> YOUR COUNTY from Motor Vehicle Taxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> •Read instructions on reverse side <br /> Appr rs Name �.,._ `` ( �l _ t ` �' County ' Type of Ownership <br /> t e k.1 Sx]t.49'in i es �l 2,reo• tr 4Ylte�r a.atc ..‘is.,, x Nonprofit <br /> Street toorgqOther Ming Address �"`J ^^ 1 // Coxmy Nrnbar Corporation <br /> 184 `'i S S4 P V x 1$(m J ❑ Other(specify): <br /> City ^ _ak1111 , \State f Zip Code State Where i{tmrporated <br /> /l- 'fir AJ LafSFsO�- - 1V �' <br /> Identify Officers.Directors,or Partners <br /> Title Name,Address,City,State,Zip Code . <br /> Par R4 4 , cka4- <br /> UST SPECIFIC DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach additional sheet if necessary <br /> Registration Date or Date <br /> Vehicle Make Model Year Body Type Vehicle Identification Number of Acquisition If Neely <br /> Purchased <br /> Vri r r2ao 'f --rAt,A_ru-s i FA?F3a145+1It X3"(3 Q) <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> ❑Agriculturaw aitonal $Educational ❑Religious ❑Charitable ❑Cemetery ex blue vely as <br /> indicated? <br /> th <br /> Give detailed use of e including an explanation if multiple classifications exist AYES E]NO <br /> //l <br /> ( -,C 11t._;.a ,Sit c �.0 5t 5 CASE— Z-cay. rsYy If NO,9ivve perteentage: % <br /> VOC_ar-Ltm -7. c'- )c-t- Wire_ tr c -4-LSv\ \re..h.cle_..list. . <br /> SIA.Q�.7t-k' t> Ct-s�,3,11 Qro V a e Ws • <br /> 1 Under penalties of law,I declare that I have examined this application and,to the best of my irn r awed and beief,it is correct and <br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization owning said property does not <br /> discriminate in membership�emplooyment based on race,color,or national origin. <br /> sign ei,�'� "` , r° j iY <br /> here , T D <br /> rr--��// R E FOR COUNTY TREASURER'S RECOMMENDATION <br /> t,7APPROVAL RECEIVEDMENTS; 46,-en l2r.ri 4/f S. X 77 4'02- <br /> 111 DISAPPROVAL JAN 1 4 2015 /�` <br /> y �� y �ay /.--/ -Z9 <br /> I TQEY.L 4 RS FSORIO! r Signature of EQUALIZATION Treasurer Date <br /> ��it11 UNTY WARD OF EQUALIZATION USE ONLY <br /> RAND ISLAM) NEbHASISA <br /> fig APPROVAL COMMENTS: <br /> ❑DISAPPROVAL / <br /> Date <br /> Nebraska Department of Revenue Awxodzed by Neb.Smartt 577-202(1)(e)(4560-3185 560-3189 <br /> 96-253-2006 Rev.52009 Supersedes 96-2532006 Res.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />