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men --e____ Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To bellied with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicants�/Name <br /> ��,-. n� �/\�/� /'�, -- Type yof Ownership <br /> .._ ' "_i2L v CZ.}- ./ .`1` S..t;A�-� XI Nonprotit <br /> Street or Other Maili dress I County _ •-�Corporation <br /> 11 -_ ` rl 531,—___.__— _ _____,— -1.`� 1 Other specify). <br /> Ci State Z Code ( State Where Incorporated <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION I <br /> Title Name,Address,City,State,Zip Code f - <br /> Pcr c,NWrr-c ,APr,-F -_. _ BSc �� rn.�en4-n3er f'/!, �IA-.gj a Mona sTca n d ,- T <br /> ''I_cPO,SVC« I[c f<-�hucd tio(tio�s -.).D7 S -(n-% C-ran Zslora,.l!{= <br /> 1 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> I •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> a&.3e — 5 fir+ Yac1 P.1P1L05 s W.._7 716 <br /> • <br /> — _ _- + <br /> . ; • <br /> Exempt Uses of Motor Vehicle: ..::// I Are the motor vehicles used exclusively <br /> _I Agricultural/Horticultural ,Educational lrC,L Religious I I Charitable ❑Cemetery i as indicated? <br /> Give detailed description of use,((including an explanation if multiple use classifications exist: RYES NO <br /> Pt Vcnc ccuup� Use cctc +Vo.*Y, t1-rittol cR AQ< ract csn..scixoo • 08 a If No give percentage of exempt use: <br /> Chc lelm. on {elc�--t-;ps of a4tcc scko l transpoeit anon, re'c`-\ <br /> 6. of:la( ur sJ <br /> r . � ce G n c crthet'S a.� <br /> r 11 �' c i-ct' is <br /> use c..\. kb s <br /> PP <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 correct.I <br /> also declare that I am duly auto h�o�oriiz.eeeddtto sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in member or employment 1 race,color,or national origin. <br /> sign 30 J.(7�nr <br /> here Audio ze gnature e Date <br />•I FOR COUNTY TREASURER RECOMMENDATION i <br /> APPROVA RECEIVEDCOMME JTS: 6P--"Mt/ Ala S *. adr-77—a 0.2+ <br /> ❑DISAPPROVAL - ---- <br /> AUG 6 205 ��= __9 ' jf(°s'� e' 7-�� <br /> Sim gnature of ty Treasurer Date <br /> `_- _ FOR CO_ UNTY BOARD OF EQUALIZATION USE ONLY _ • <br /> • <br /> TREASURERS°FFK`x <br /> APPROVAL GRAND ISLAND,NEBRAS$Annsec-TS: <br /> ❑DISAPPROVAL Afar Ape <br /> r• zed 'gn.i Date <br /> Nebraska Departmem of Revenue Authorized by Neb.Rev.Star§571202(1)(c)and(d),and 60-3,105 and 60-3.189 <br /> 96-253-2006 Rey.0-2011 Supersedes 96-2532006 Rev 5-2005 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />