Laserfiche WebLink
Neb n_. o, Application for Exemption FORM <br /> REVENraska REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> UE G •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> licaant' Name �({� ant. _(\�/� Type of Ownership <br /> r1+}�Q( � Alder-QS 1 a� lilt I V Vc I �i� Nanprofll <br /> Sieebol Ocher MaiJpg pd� /� 'r ` County I // Corporation <br /> .J�,,l(j Ater i K ,Qi o owl, <br /> 1, /{-,i� ❑Other(specify): <br /> �rarlc� �s1 � � ct <br /> State i SateWhetpoaed <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Ti+ Name,Addr,ss,Gity,�State,Zip Cooder /_1�, _ <br /> t1G� Mfrs i 50.. " . ,e., 1 1 . Gr.. rrcDLC$ '. je{ tU - •' /R i.�j <br /> ait �E� (Cy +r'oc.5 !'-M? -' r ,LC_ — (' O) <br /> A4sNfey GIOLhOif ! , 5 y Pctie- -�elRs /E- lbfl20 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Modell/ear Body Type Vehicle ID Number Date of Acquisition, <br /> if N- .' Pu sad <br /> Mee 01 vex o #s Ma II I MI g lailEMINSIN C�1 tg.rrera- 'G'/.�lWArt: <br /> • <br /> Exempt Uses of Motor Vehicle: ,,-.// Are the motor vehicles used exclusively <br /> ❑Agrirultura&HonirxAhaal ❑Educational ❑Religious LYE Charitable ❑Cemetery as indicated? <br /> Give detailed description of usse,iincluding an explanation if multiple use da ications exist:6'J ' %47E4L/� gES ❑NO <br /> /�� CiY An /1Z-7 (�T percentage of exempt use: <br /> Zed Pe aes C(2o79�n�� / �6 7��} (lo d_-' <br /> ataent' 4/Gn' At <br /> Under penalties of law,I declare that I have exami 'this ap on and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that 1 am duly authorized to sign this exemption 'cation,and t hat the organization owning the above-listed properly does not discriminate <br /> in mem 1.or employment b--=I on race,color,or national origin. <br /> sig `-t, d..tf•. / ' eTA aAa he . 0 ed Signature 'r Title <br /> FOR COUNTY. TRREEAAASU,RER RECOMMENDATI.O/N <br /> [ PROV\L RECEIVED COAMENTS: `" " i/ 'vy'La #rr—pow <br /> ❑DISAPPROVAL SEP 2 1 2015 <br /> 64 ° 9-.2.V-/s- <br /> watt f`ft INTY , � as <br /> Signature of County Date <br /> I GRAND 3URREERRSNOFPIOER COUNTY BOARD OF EQUALIZATION USE ONLY <br /> y(�APPROVAL DRACKIIFOCOMMENTS: <br /> ❑DISAPPROVAL <br /> �514 ../.. / 70-O'16— <br /> orized 7. `���� ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat§§77-202(1)(c)and Id).and 60-3,185,and 60-3.189 <br /> 96-253-2008 REM 8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />