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e znto <br /> Nebraska Department of a <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> YWCA OF GRAND ISLAND <br /> ®Nonprofit <br /> Street or Other Mating Address County Corporation <br /> 211 E FONNER 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 OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <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 /> (.,-.; egoo F3oo, Vain iFBSS3(L % <br /> 33MM569a <br /> Fox-.- Ivtlo C1 So vc.,_ ,,FMEE11HITOb51,6'7 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriatturaVHorticuhuml ®Educational ❑Religious // Charitable ❑Cemetery as indicated? <br /> Give detailed description of us e,including an e xplanation if multiple use classificatio ns exist: )YES ❑NO <br /> f f kns w&io aey-) V`- eiti L cn are m Se m' opt <br /> 'f e (,1-1 If No,give percentage of exempt use: <br /> tgleiscn lid( 91cx'Yrcrn . <br /> s d .11.rid 111)--S <br /> Z ' rC,�SU�ot�. till �,�-C- <br /> i-i'• QiCk.- wf &A- 1Ato &RIK CINIft'-'.n a4. 1-C1'Z _ <br /> tt Under p nalties of Illv{,I declare that I have examined this application and that it is,to the•--- . y knowledge and belief,true,complete,and correct.I <br /> also declare that lam duly authorized to sign this exemption application,and that the organ( • owning the above-fisted properly does not discriminate <br /> in membership or employment sad on race,color,or national origin. <br /> n v <br /> 4,Qtailtiv ale;iv here ' ignature�y iemi 30G. -q net?arcs D e <br /> FOR COUNTY TREASURER RECOMMENDATION / <br /> E PPROVAL OCMMENTS: �'� 77-��� <br /> ❑DISAPPROVAL <br /> RECEIVED A�y.�tQS. <br /> NOV 1 b 2015 SgnatureY Qe.¢a, , suit /6-7-/6--,s, <br /> I FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> MALL bum <br /> TREASURERS OFF ICE <br /> 'APPROVAL GRAND ISLAND,NEBRASICILUOMMENTS: <br /> l❑DISAPPROVAL _ <br /> „ /� <br /> i at �2/ , �D L,5 <br /> '1a ., T- ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet§§77-202(1)(e)and(d),and 60-3,185,and 60-3,189 <br /> 98-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />