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A/05/2016 17:37 3083841555 NEBRASKA STATE FAIR PAGE 02/03 <br /> ri ,5 26/4 <br /> ---c - • is plication for Exemption FORM <br /> N.b.aak.Ovoaronent 0-r <br /> REVENUE fro otar Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> izignscim •tb be flied w*h your county treasurer, <br /> .Read instructions on reverse side. Tyre d Ownership <br /> (iek Name /1 <br /> Street JTA�G �Gt{Y Jl SWAY-Gyl ❑Varp rats <br /> SVeet or Other Mailing Addr08Y <br /> .�N FxPOrelwr' , <br /> -Po &c 13 —7 ❑ou u(spedyY <br /> State 4,code State Where incorporated i <br /> Lretyld 1s1al of 1.1� ( 2 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Mae Netne,Address,City,Stale,Zip Code <br /> -X Ste_ tli-ethied I14.6 <br /> I <br /> I <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> -Attach in additional sheet,N necessary. <br /> Reg' to Date a <br /> MotorVehicle Malre Nodal Year endyTyps Vehicle ID Numbs Data catisi on <br /> ClMVy �cictl�� 2412 gunk 1cctXVC4Icx.aZi 5 v/ -/G <br /> / - Are the motor vehicles used exd1191w1y Cemetery Exam gt1c of MWKor1i hide: t-� as indicated? <br /> AgncuaureuNarfcultumt ❑sduaalionel L„ Pargiods ❑Charitable ❑ <br /> rlede use classifications exist I�IYES ❑ <br /> Giro detailed daswipkon d use,Inducting to explanation e m �/ <br /> 114■s ` , f Gtaie. If No,give PercentafleobaxemPtu$e' <br /> / velA:L1� }I� 1�Stc1 1OY /��W(G151� +" % <br /> t,F A5v.c. /,ti1�tu e.. 0-44 &1S4 I pm/pests oraltint,tt IWt4nt, <br /> Ciyiverr oAs axd g in Pves. <br /> Under penalties d law,I declare that I have examined this apphCatWn and that it B,to the best of my knowledge and Wei,true,complete,end correct,I <br /> also <br /> n�declarethat I am dutyutorised an race,colo � og�. that the organisation owning the above-Rated property does not 6udmmee <br /> in sign ' ° - 4 AO <br /> here ' • • ^ m 41 Data <br /> FOR COUNTYTHEASURER RECOMMENDATION <br /> +ET'6PROVAL RECEIVE M"' s: " -42 4 •77-1-,:a0.2-e <br /> ❑DISAPPROVAL <br /> �fQ� /'77t% <br /> JAN 2016 �agrWN�Leawe Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY I <br /> 'TREASURERS OFFICE <br /> *APPROVAL, . GRAND ISLAND,NEBRASISSIMFr4rs: <br /> El DISAPPROVAL a , a art, <br /> tin//,,!jl r,f% <br /> Names OapeMeno(Repwe Neeed2ed by Nab RStsu45f Tr 02(1)(e)ern(4 aid 0-0-3,156.and 10-3,159 <br /> 9s-253-203e Rn+.a-2011 SupBnedar 96$OR006 X65 2009 <br /> . PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />