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<br /> n^—'Z Application for Exemption „ FORM
<br /> Nebrar 2 Department or
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organization
<br /> your irer. r r t_ 457 b on reverse side.
<br /> Applicant's Name Type of Ownership
<br /> ORPHAN GRAIN TRAIN
<br /> Street or Other Mafiiog Addre s M, .I-i Y 6 4 D O it ess County ®Corporan
<br /> 427 N SHADY BEND RD Corporation
<br /> fie- /SGS, <fnsr. ��s�Na �f�9°a ❑other(sRe000:
<br /> City State Tip Code State Where Incorporated
<br /> GRAND ISLAND NE 68801 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Tele Name,Address.City,State.Zip Code
<br /> 13Ralucli MIA-104-6 Ert R 6<+ay Cvrc_CK5 5y3-577 CrcCeacft RDyGems iritmon. <rra- E8fr°o ,+
<br /> /+ssi- maa44 ca 1-RUe• A/ DPXeZ/903 V h /}✓P._ ne.4k'Ney, NC 6>r4'ys '
<br /> Secre."1-4-«1 ,o,t! leliaW e, Sao Lv L<stilso.v 57 BLUt' rtI /vim f8y30
<br /> -y."`/-ecrs�r e v Br rht S7--/egp1l , le0- ,G6)( 157, .CNGAN 9, NE 4. S?S14 _
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> *Attach an additional sheet,if necessary.
<br /> Registration Date or
<br /> Motor MOdetTear Bady7yps-- TeliclB A.NUmbei-- Data of AcWui S or
<br /> _
<br /> if Newly Purchased
<br /> ,0047 %3 so god- PiCKU9 /ftSW30;l.-2663Y5A7 SF}A/ ac),(
<br /> P'I.dvtledJry 6 "l2 Co (0 1-;",4-rLer- 5/7R41E/a/oMjfrb4' 22 5,?rw a-"
<br /> too If 4:x/6 ao1a 'r;-,u: l-e, 5367--/4 zy6.4cog23Fy _ ,i2dy, 2n l/
<br /> Yin/c- of t.Ge ,QaA-b /725 rilvrAorhomp - C $9il3142sc atinoacce, /a-/+'-/3
<br /> ff -4- N 6 v. 12 ,2c, /5 TRA-7<-e. 533scit 3iItCc2•(86y3 7- 7 - 15 ,
<br /> Exempt Uses of Motor Vehicle: Am the motor
<br /> vehicles used exclusively
<br /> as indicated?Agricuaurasortixsarat ❑Educational ❑Religious I7Chartahle ❑Cemetery
<br /> Give Staled description of use,Inducing an explanation if multiple use dasslications exist 2YES
<br /> ❑NO
<br /> Lii D oR F O NDI 75'1A X / c-f-i a Pi-cs 4-
<br /> of reL Q-c/ S -p�
<br /> ,c_rc 3 i .tot L 0 11-Ec f/N6' D o NA7icus o E c L a i
<br /> cof l�.edx ice. If No,give pementage cif exempt use:
<br /> - prLees /7-ND / dOs ho/ci CoecOj f.v Cetr1r& L AIE %
<br /> 4-
<br /> N0 A/0, r t f C croZ`-rc1- Y/r-N9HSo
<br /> Cb<.. -i-A-c is 6•4 R y w/rcK 308- -2&%o - 623 . -
<br /> Under penalties of law,I declare that I have examined this application and that I is.ta the best of my knowledge and belo,true,cortplete,and correct.I
<br /> also declare that I am duly whacked to signals ece pxbn application.and that the lion owning the above-mod property does not discriminate
<br /> h ma'am/ship oremployment-based on race,color,or rational origin.
<br /> sign / / /
<br /> p i • giticP iliiip�fY //A 17-26/.5"
<br /> here ; • . The Date
<br /> I FOR COUNTY TREASURER RECOMMENDATION
<br /> APPROVAL RECEIVED Gomm Ras: -- , ,A. _. A .-rd -77— --
<br /> 4.4.TR£450
<br /> ❑DISAPPROVAL o°oeecr¢ yam,
<br /> NOV 232015 s�
<br /> Signature of County Treasurer Date
<br /> ASL�GO$�CO�Y BOARD OF EQUALIZATION USE ONLY
<br /> TREASURER F
<br /> �/' URAND ISLAND,
<br /> qJ APPROVAL COMMENTS:
<br /> `/❑l DISAPPROVAL
<br /> 1/i I
<br /> ..II s. Al /// - I��
<br /> Nebraska Deparaanx of Ramada Amhodzed by Net Rev.SIX Tis77-2CQfl)(c)and la).and 603,185,and 603,1ae
<br /> 96-253400S Rev.63011 Sxparaedes 96-253-2006 Rev.S4L09
<br /> PLEASE RETAN A COPY FOR YOUR RECORDS,
<br />
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