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Application for Exemption FORM <br /> Nebraska Depenmem of <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 J / Type of Ownership <br /> 146.-11.4 LA" I �c i WY Street or Other Mailing Address // r County/77 J/ Corporation <br /> a?oo Li t-/ sbcr G( <br /> y Other(specify): <br /> City / State Zip Code State Where Incorporated <br /> Gr.,1 Ts <br /> e-c-j AY Cflb3 Ale <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 5140eLahe Ntro-x541Psr• , 3327 PC 7,4;2 _ n f�n._.1 c¢-rfia.--r 6Pet,2 <br /> -c Leo Mar-I L.sts c 3/to Qf � � �s/ l / .rare <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear BodyType Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> ZOO n 1T7TRzcz73ii3183/ 7/zr/.s <br /> • <br /> • <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticulfural Educational 12 Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: RIVES ❑NO <br /> 71r / <br /> ,6 t rS ' 6J �'°'E 'f'�t :_.� f 4.. ->ly E- h- C..m.'L f r:r If No,give percentage of exempt use: <br /> 4'r/a) <br /> Under penalties of law,I declare that I have examined this applicationand 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 based on race,color,or national origin. <br /> sign p <br /> rXLC it actor <br /> here I'AUthorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> PPROVAL RECEIVE[ Al.�� �7 4 0 2 <br /> ❑DISAPPROVA` <br /> AUG 42615 e SI- <br /> Signatu unty Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> 'MEASURERS EASURERS O <br /> � <br /> A.fAPPROVAL , GRAND ISLAND,N EN—S: <br /> ❑DISAPPROVAL / <br /> A/.%/ .% <br /> �nzed S• re / Date <br /> Nebraska Depanmerd of Revenue Authorized by Neb.Rev.Sat.077-202(1)(c)and(co,and 60-3,185.and 60-3.189 <br /> 96-253-2006 Rev.a-2011 Supersedes 96-2594006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />• <br />