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+tom.. Application for Exemption 2 () IV FORM
<br /> Nebraska Department of
<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 /> BIKES AND TRYKES OF CENTRAL NEBRASKA ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 3004 W FAIDLEY AVE HALL
<br /> ❑Other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68803 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> Pres',c(tnA- 'QkOA Andrew= Zoo t3 Si-ft.x4 SYU■ker,, Nc fo'%7b
<br /> 1),L.._ Pt2s41.,‘t- tc.cc.h Scacma 7.rr4 3 S-trtz} Slv n,JF (.r 847b
<br /> Sec . leb PIN,nnei 3444 sShc,ct1Berkect Gr,1Jc (4V'I
<br /> Tres. U,cy. l Klan ttsol A, Sheridan GI- , )1■1 E (o8kol
<br /> •
<br /> DESCRIPTION OFTHE 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 /> ReTmsVLrS to12, -111(17 1 ERA$EI6Z4CMS11451
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ID AgriculturavHonicutural El Educational Religious t Charitable ❑Cemetery as indicated?
<br /> Trwltr
<br />• Give detailed descrptlon of use,including an
<br /> 1` CLf an explanation if maple use classifications exist: ' YES ONO
<br /> U €. c_ r.ox. Ilxo!�,k serum- er&yi,TF.Cior\ - w2 i)TCJ-.CLL If No,give percentage of exempt use:
<br /> --`.eTaa\-lc irykcc 9,
<br /> diSable� ch.AcAren a+6 ac`w\k . T loo %
<br /> 4 o 'tr w.tt b-C used hov\ 141c,$ AD b lcl int
<br /> Under penalties of law,I declare that 1 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,color,or national origin.
<br /> sign ci 49,Ad/^',ANvi V i t ho li y
<br /> here I Authorized Signature Title Date
<br /> FOR COUNTY TREASURER RECOMMENDATION
<br /> [ APPROVAL I.UMMENTS:
<br /> Tr-
<br /> -'�r'" '-4" Al. ` '� F'C ,�f.-
<br /> R RECEIVED /At�Te�,�
<br /> ❑DISAPPROVAL r�.,efi�g
<br /> U cCw1 R
<br /> SEAL
<br /> 'Signature of County Treasurer �C' ' Date
<br />••
<br /> 11,1LL COtz'd-TY FOR CC UNTY BOARD OF EQUALIZATION USE ONLY
<br /> TREASURERS OFFICE
<br /> GRANO lS LAND, NE BRASKA
<br /> APPROVAL LA)DAM ENTS:
<br />•
<br />' ❑DISAPPROVAL ///A,._...41 ////it / / o `S
<br /> A M rizd Signet- -°'
<br /> Dale
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 603,185,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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