Laserfiche WebLink
Toe Fl WITH Application for Exemption FORM <br /> YOUR COUNTY frorn Motor Vehicle Taxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> *Read instructions on reverse side <br /> Appkranta Name . Type of Ownership <br /> oaaw, Cl 1-1,41,.,_4,-Les oc Cren4-e—r N k`lore G-rilt A l t <br /> Street or Other MaWng Address County Number ion <br /> 13n4 S t S c Pc Ent. tWo3 ❑Other(specify): <br /> City State Ire Code State Where Incorporated <br /> ('rani- isl Pet Aa lJf_ Co680a ►J2.- <br /> Identity Officers,Directors,or Partners <br /> Title Name,Address,City,State,Zip Code <br /> Pt2 krri atc17 <br /> i LIST SPECIFIC DESCRIPTION OF THE MOTOR <br /> *Attach additional sheet if necessary <br /> Registration Date or Date <br /> Vehide Make Model Year Bony Type Vehide.Identification Number 2fArtduledieng Newly <br /> rcrulaaJ <br /> a. NA#4/ ann'1 innPALA ,aa1vt'CS1Vj(dl13tatt1 <br /> Nature of Use of Motor Velide: Are the motor wehides used <br /> ❑Agriwuurawwrawltural Nil Educational ❑Religious ❑Charitable ❑Cemetery exclusively as Masted? <br /> Give detailed description d use.including an explanation d multiple daasacaliors exist ,YFS ❑No <br /> 1�Sea d � Pc,k,' � mitt #-akiAn hafY,r_ It No, % <br /> CAI efv4'S or St. Pp°•-� t t'e \-5 ac---H tl't tr y <br /> and_ -zrainir.1 . <br /> Under penalties of Pm I dedere that I have WmEed this application end,to the best of my ta+wdedge and beret,it is rnnect and <br /> complete.Iadsodedeie that I am duly authorized to Mgr,this action apprscation,and that the organization owning said property does not <br /> discriminate in membership or employment based on race,color,or national origin. <br /> , , i / <br /> • I / F v <br /> r <br /> here _ Tae <br /> ..a : ate ' TREASURERS RECOMMENDATION , c �i �7 i <br /> PK <br /> ppR• -L co arm: <br /> ❑DISAPP'. AL JAN 2 9 2015 S 2_/ <br /> re Ceuny�easser a- <br /> .ib kik _ Signature Treasurer Date <br /> -�-,-- .. !-..'_..!ho NTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Nebraska Department or Revenue Audrodad by Neb.Rare Slat 9n-2020 xexm.46oa1as§e04.1ae <br /> 96251200e Per 4-2009 Supersedes 96-259-2205 Rev.11-2o0e <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />