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. Application for Exemption A
<br /> �z 6 j FORM
<br /> Nebraska Department of
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations
<br /> •To be filed with your county treasurer. //4 C z----- 457
<br /> •Read instructions on reverse side. I
<br /> Applicant's Name Type of Ownership
<br /> ORPHAN GRAIN TRAIN ® Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br />•
<br /> 427 N SHADY BEND 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 /> Title Name,Address,City,State,Zip Code
<br /> �RA( GN YlNHG -,.c GfRY Lc /EGK/ S5S i -CCC64C / /R O. GRD�Sc 6i.kW"/ ft.,i� Leg b/
<br /> A- r - f1A-11-)4- E,{ LI va_2u i1 xG, r qo 5 t" h✓c , k The lu -4r .!v() 18.9 '!.5
<br /> <e e ,--pi 14-ny, RO/V KUE riNg.Q , 65O Ai G1; /L5 Et✓ 5t/ ✓�/LF hL//-A , ,v-C� L5go,g
<br /> ��i 3 Crud- E eve 5i1-R3'7, i o. YO / 5-7 kits, , /Vr' (� 8Y - z
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> Registration Date or I
<br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, I
<br /> if Newly Purchased
<br /> con C aorsb ->ii.,, k4 /C077c / 276P10/23S 7-/-/r'
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricultural-Ionicutural ❑Educational ❑ Religious ('Charitable ❑Cemetery as indicated?
<br /> Give detailed description of use,igdudi g lanapon if mutt' a use classifications exist: �1'ES ONO
<br /> c) S1st 10,e 1-i r A-)5ias& zc.Tec✓4 'r,' 5/i> /,' dr
<br /> e F' .i.4---E/if c5 /-}N Q C G C l e C- V-7;/11% 6 Po"IA 7/CNj e rC���tag-I If No,give percentage of exempt use:
<br /> teL ' , /ill) cG /?i ; t Ce,,.2`r�J Ar'eg
<br /> tined y “iep4;es oet.e�o lCooP %
<br /> fifty") go id; Co.44 Va.I- X71,&5 '
<br /> 30 s2 3pa oez3j
<br /> , !ci / `cv
<br /> C c-itJ 7/c.-. ChR
<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 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,cobr,or national origin.
<br /> sign /�
<br /> V z fxJ ig R-4.4 NA/it:E r^ ///j-aZ0/S
<br /> here ) uthodzed Signaturre Title Dale
<br /> / ron NTYTREASURER RECOMMENDAT ION
<br /> ,,_,/ ,L.4 i /Il 7 -ra'te'=d...
<br /> @APPROVAL COMM NTS: """ f" aA '
<br /> �., Ja®G�
<br /> ❑DISAPPROVAL . �`�'
<br /> 114)")( Ss 0' /12°/1,2,-;; -/.,`
<br /> HALL COUNTY
<br /> TR,:A.SURFRSOTTICE Signature of County Treasurer Date
<br /> c,r.MNU '5LAr<U,N E‘th6F<gateGGIUNTY BOARD OF EQUALIZATION USE ONLY
<br /> ❑APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<br /> it Authorized Signature Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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