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_} t - .c <br /> e�- Application for Exemption e FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organization <br /> •To be filed with your county treasurer. 457 <br /> cznaumelinm •Read instructions on reverse side. <br /> Type of Ownership • <br /> Applicant's Name <br /> CENTRAL NEBRASKA HUMANE SOCIETY © Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1312 SKY PARK RD HALL <br /> _ ❑ Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> r <br /> Tip- 4,.me,,AAdd�re .,City,�State,Zip Code Cood■ee /� r /�� ��� <br /> late !rI!����1�111Lra r1 arMi�lllh i / 4+1771111//, r _ X111 <br /> V i . r ES'• en. e•50.- r � u i . • arra T om: - a' S?Zw ►�1 Scalj, <br /> itosu.rcr' P -bores . • '3 traint...s 1A6 ran& .,_. frail <br /> E eb llarni1 �Z'. . „ z A .ff :T.lLLL,a ei •Ear •+h.L�R!r:o( <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •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 /> if Newly Purchased <br /> Ms I •r Jos • Sri II:ZaCesEtrez•JS7U''7nE . <br /> reintsel ua D ' Ai4! atl� !7' ► ' D0 • - r , b7S! <br /> ` � M1=7.MtinelanE !� i <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> as indicated? <br /> ❑AgriculturaVHorticultural ❑Educational ❑ Religious Charitable 111 Cemetery <br /> Give detailed description ol use,including an explanation if multiple use classifications exist: j� I . PIES ❑NO <br /> 6 p /tIJ , '' , T 77 /In_A p ,-;? w'r/IIA1 1 If No,give percentage of exempt use: <br /> (.12„..,j/i . 04L,(4)1(1A--CSLti Ka &Li). % <br /> Lhn Con,-/-it 4 u <br /> Under penalties of law,I declare that I have examinedthis application and that it is,to the best of my knowledge and belief,true,complete.and correct.I <br /> I 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 �� y�,0J //-/qac/6 <br /> here*A odzedSignfl Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> DOMMEPTS x <br /> °'APR°VAL RECEIVE A <br /> ❑ DISAPPROVA_ [��� 1� <br /> Brit 3 n 2015 — i°O' �5 /2- .5 /_-,-- - <br /> , Signature of County Treasurer .:AN" Date <br /> 1 . <br /> HAt t rnu&T+FOR COUN ry BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> DISAPPROVAL ' <br /> 7 prize' ;n- 41111- D to <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77.2o2(1)(c)and(d),and 60-3,185,and 60-3,109 <br /> 96-2532006 Rev.8-2011 Supersedes 96253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />