Laserfiche WebLink
Nebraska Department of <br /> 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 Type of Ownership <br /> ip <br /> -nu._E m 4 aft SAmq i c� (,._ 3/maa SCd Wood 4 ❑Nonprofit <br /> Street or Other Mailingdresss County Corporation <br /> 'VFW i^ I�� { 46`1 <br /> ❑Other(specify): <br /> City State Zip Code - Stale Where Incorporated <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ?Ioaac Sep , a <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType ' Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> terd1tFion SE. X015 'F-l1 -r Sedan 3Fge10 0 1+1SFRa3Bh4 't sjq,(/5 <br /> Exempt Uses of Motor Vehicle: a--,. Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural IY,ural ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: DYES 10 <br /> lraue ( 4.0 i ce (Mc� ��( iits) Sbi <br /> " If No,give percentage of exempt use: <br /> Traxe,' ±a a55 eamtvseo 'C o & <br /> Ro % <br /> an �a� O ttWnQc i5Soca, far kouAti' <br /> cuink 6a lCuAc isms ileMoukt lau.A h ad(dt9-fb i <br /> f a it U4 ucnLLOe 6tW Jt a a .o2 civatc , <br /> 446 <br /> Under wallies of law,I dedare 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 I 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 tbbaseed on race,color,or national origin. <br /> sign S /v� � {.7no L+e,10 <br /> here ■Authorized Signature Tit Date <br /> �p <br /> FOR COUNTYTREASURER RECOMMENDATION .y y <br /> PPROVAL RECEIVEVMENTS: ' y A ' ' *i / <br /> ❑DISAPPROVAL <br /> MAR 6 2015 di 3,o,>.sd <br /> ►Signature of County Treasurer Date <br /> HALL COUtfOR COUNTY 6OARD OF EQUALIZATION USE ONLY <br /> GRANDISLAND OFt-CE <br /> GRAND ISLAND•NEBRASKA <br /> APPROVAL COMMENTS: <br /> 111 DISAPPROVAL / a i / <br /> Amor 4.41r' ,II di <br /> (prized Signalu'tY" Dater <br /> Nebraska Department of Revenue Audioreed by Neb.Rev.Sat.§$77-202(1)(e)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 98-253-206 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />