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• <br /> Nebr DapaZnof Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> REVENUE <br /> •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> A li�a/s,Na /� �j/ • Type of Ownership <br /> PP 4o a `u( cA✓! 'YY C L K A/ 4' �/!✓!✓74 6‘/,, ❑Nonprofit <br /> Street toor-Other Mailing Address / /,//� // Couynn / Corporation <br /> CJ J 78- \ ?eja�(C /pi 0°'7 // IL.('r - G X ` / ❑Other(specify); <br /> City / ,� / State Zip Code State Where Incorporated <br /> IDENTIFY OFFI S,DIRECTORS,OR PA ERS FTHE NONPROFIT OR NfZAT10N <br /> Title Name,Address,City,Ski:,Zip Cope ` <br /> Affirfila l�{�TAIIE ICKI AZsW® �S an . yam' • r n <br /> r _ r 5'✓1 . f37fZ� Sflel(al�:��'C V _ _ _ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear Body Vehicle ID Number Date of Acquisition, <br /> II Newly Purchased _ <br /> ( I'4 <br /> in <br /> `/ �� 0O L L. / I s A. s . )f <br /> Exempt Uses of Motor Vehicle: ttom�,,//// Are the motor vehicles used exclusively <br /> ❑AgricuMaalmorticult rat ❑Educational ❑Religious heritable ❑cemetery <br /> as indicated? <br /> Give detailed description of use,including an wrPlanatlon it multiple use classifications exist: DYES ❑NO <br /> IIS>°S 4 $`/ re-a//t/' Atli/ z- GO air--/S % pro f+901c II No,give percentage of exempt use: <br /> 5 A ki r...Ks r%so,--4 / 6 r Cif J✓r n <br /> , <br /> 4 Under pansies of law,I dada's that I have examined this application and that it is,to the best of my knowledge and betel,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..: .n race,color,or national origin. <br /> • <br /> sign f -�; <br /> �' /ila►r Ilea J [P-G 1 i <br /> here Authorized Sig slurs - Title Dar <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ®APPRCVAL RECEIVED COMMENTS: - ■ t .y"45. Ar77 Sca. <br /> .T <br /> Gt <br /> ❑DISAPEROVAL <br /> ` " 'dt ,DEC 1 2015 ctm ./2-/d-/- <br /> (t Signature of CountyTreasurer Date <br /> I §fit L rnUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY 1 <br /> TREASURERS OFFICE <br /> GRAND ISLAND.NEBRASKA <br /> gAPPR(NAL COMMENTS: <br /> s0 DISAPPROVAL <br />• <br /> g re ele,a1245 <br /> Nebrasla Department d Rawue Panned by Neb.Rev.Sat.§$77-202(1)(e)and(d).and 60-a m,and 603.189 <br /> 96-2532006 Rev.8-2011 Supersedes 96-2542036 Rex 5-2008 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />