Laserfiche WebLink
Neb "-�� Application for Exemption FORM <br /> raska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> mormazie •To be filed with your county treasurer. A 57 <br /> •Read instructions on reverse side. Ya7 <br /> Aoolicam's Herne Type of Ownership I_)Cftbr CAI t Z&nci _J Ar1(tk51 I 1 e.7, <br /> Nonprofit <br /> Street or•her Mating Address Cou 1 Corporation <br /> ❑Other(specify): <br /> State Zip Code State Where Incorporated <br /> nrn Nli .1_,c IAnr9 N L_ i Nf- pN <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 5e Cit —CA_CV e/ <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make Model Year Registration Date or <br /> Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> OCAS e_ d0in. hra 4 G:,t-. ..,A a132-1RNSox5 R ichAil5A. z-t7-6 <br /> Exempt Uses of Motor Vehicle: ����qqq{ Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious ICaCharitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ry/� �•ES ❑NO <br /> ran t� w 5 c d r de L jP,r t n,� \l c me oi e 1 i V tj If No,give percentage of exempt use: <br /> Mtal5 tt 'Hine e cierl9 ana disabled ;rue q = <br /> detis(J c to.etic in Protift, i oY-A { r <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 cared.I <br /> also declare that I am duty authorized to sign this exemption applicaaon,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 '74 . � •.� J�t,,uthaksh ' (1t aa-ak 41‘..0115 <br /> here Authorized Signature Title Date <br /> ,�,� FOR COUNTY TREASURER RECOMMENDATION <br /> te4PPROVA RECEIVED �°5-�• "`7� �- <br /> COMM TS: <br /> ❑DISAPPR AL <br /> MAY 1 2015 � 2 .,r-/-/g <br /> • Signature dtC linty Treasurer Date <br /> HALL COUNTY FOR CO TY BOARD OF EQUALIZATION USE ONLY - <br /> • <br /> I,_,(' GRAND ISLAND NEBRASKA <br /> VIIAPPROVAL COMMENTS: <br /> /❑.DISAPPROVAL _—A 410 / <br /> "oAr ,na'' OS/5" <br /> .•r prized S., _tut- r DIU <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 803,165,and 60 31119 <br /> 98-253-2006 Rev.6-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />