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Narak.D Application for Exemption FORM <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 f" �I. // Type of Ownership <br /> NJ. Ntbroxs EA, 1nhi,;Jrat $micas tm Nonprofit <br /> Street or Other Mailing Address County Corporation <br />• C <br /> a c 3 G 0-1-6.-t sot ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> I; 15 (co el ,v i G fle 3 IPE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFfr ORGANIZATION • <br /> Title Name,Address,C State, " Code <br /> City, Zip <br /> SA,.al r• en 1d:^ <br /> V TLS Ck&ir Arta. v. <br /> PL/17C(LS4 y't: r <br /> CEO <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 Date of Acquislaon, <br /> if Newly Purchased <br /> ooJc t 2a t3 Spaot tto.at Z G4_RDGCGItJK51to 3 20 <br /> I-24 - l5 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑cultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed desorption of use,including an explanation if multiple use classifications exist: r is YES ❑NO <br /> Yroas port 4 toot 1 o(2 rat.fvLL%14 A t 5Gap(t CI <br /> If NO,give percentage of exempt use: <br /> (v. �: Viduua.l1 <br /> ea pr0Vide Sera1cc5' % <br /> for e.w.Ip l o t% rn X. <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my loxraledge and belief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption appication,and that the organization owning the above-listed property does not discriminate <br /> in membership at employment based on race,color,or national origin. <br /> sign <br /> here Authorized Signalise Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION ,y •-� <br /> [Y APPROVAL RECEIVED COMM:NTS. 44 A� a " #'"R°' <br /> ❑DISAPP•e • <br /> JAN 2 i 2015 di6 " �g-/� <br /> Signature of uny Treasurer Date <br /> r <br /> NALL COUNTY e R CO BOARD OF EQUALIZATION USE ONLY J <br /> GRAND ISLAND NEBRASKA <br /> /// APPROVAL COMMENTS: <br /> ❑0 DISAPPROVAL <br /> /4 f �� ir <br /> iL�; ,— i��:.. , , <br /> Nebraska Department of Reverse Authorized by Neb.Rev.Smt fd 77-202(1)(e)and(4 and 80-9,185,and 80-3.199 <br /> 96253-2009 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />