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N. ..:--L— tor, Application for Exemption 4610 FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 45 7 <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> YMCA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 221 E SOUTH FRONT ST HALL ❑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 /> ecra gtie D!✓eAo✓ 3744 Z%vla a6 (-1tu„Si//,� /94-and /sfe,4., e, [n6tv3 <br /> . . r ' %-rt' /-4.--,1- i-./ - el , -, rkvYrw P ire erTra ! isG>J :prof <br /> Ice rrrmsi:/. �c ^ ir✓k�- 41/96 elm .e 9O,,v,-, An ;'/s ,, e .��8'03 <br /> `treasurer L flul6 „n 232c 'cc4a;ra1Drive Graa,16 --r 41e b8S-aI <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 Acqulshlon, <br /> if Newly Purchased <br /> ,9 (993 1Icu' ,�..��'�15.5532!-)a Pita <br /> Ford ) el A Van �JS'ss31}tD ilizi <br /> Jlorie,41a4 Tr4;14 )94o A/ /R <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgricuiturapHorticuiturel ❑Educational ❑Religious Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation If multiple use classifications exist: // S ❑NO <br /> g0 ! ` varis` Qeteici / `Piv afro e rch4 S©v Le/ If No,give percentage of exempt use: <br /> uscA Ifit St.c/0 91 'G o(Rlr ✓`� !€n t an dC�S '° <br /> 4,4,,,c& s if at /10n ro ¢ CGtuse an <br /> �iSSio✓1 .� <br /> �� <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 coned.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above4isted property does not discriminate <br /> - in membership or employment based on race,color,or national origin. <br /> sign 2tls)Aers a/' jr 0V-2a/3--here I Authorized Signature Tate Dat <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> A APPROVAL RECEIVED COMMENTS: a t— ' .0 4% 1 c-95 <br /> X 77-`?c R <br /> ❑DISAPPROVAL + <br /> NOV i 8 2015 f se `s /a -/d'_ As— <br /> Signature of County Treasurer Date <br /> I ASI nps nr ,EjpR COUNTY BOARD OF EQUALIZATION USE ONLY TRFACILLQUNW <br /> GRAND ISLAND,NEBRASKA , <br /> JZIAPPROVAL COMMENTS: <br /> JJoDISAPPROVAL / ��f' r�/ hoA Date if 'a/"� <br /> Nebraska Department of Revenue Authorized by Nth Rev.Stat.§§77-202(1)(c)and(d),and 643.185,and 60-3,189 <br /> 96-253-2006 Rey.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />