Laserfiche WebLink
NeN Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be fled with your county treasurer. <br /> ---��I��1R- (� j•Read Instructions on revere side. wood - <br /> Applicant's-1112 Name i Al lY 1. 'lVMair 1 SCdJt RI V Tyr Type of n <br /> Street orOtlrorMaairg trees my °Nonprofit rn <br /> I lip I s-f <br /> City i 1`V V[ Sate Zip Code State Where Incorporated ❑Other(specify): <br /> NE 03 883 ire <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,C4 State,Zip Code <br /> J>L¢r:Lae S,eo . <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Do Au lDa bNotorVenke Make Model Year Bodyrype Vehicle D Number <br /> �vva on S C dai5 tf 4nr+r x NawI,Purchased <br /> ��'1 3F(�b�lj}F'15 FB23893�t?rt c�9 ��/5 <br /> } <br /> Exempt Uses of MdorVehicle: Are the meter velides used exclusively <br /> ❑Agnam,rW orecWwrl ❑Education.' - Religious ❑Charitable ❑Cemetery es indicated? <br /> Give detailed description of use,including an 7tyitt maple use classificadam eclat: ` . ❑YES ('1 <br /> )v` s Cti e.{ hot? _(Yl,ct S� Ia(Ls, SJ), if No.give psrcaN�eo(mwmpt ass: <br /> lieale71±ta.SS eampuSto tuat 0 jot, 4 <br /> a s is rdti <br /> te }ev�AleE law h9 <br /> pbiat <br /> alsod of law,dulysdare fre tosign ig thlsexempio eoon,end a the orgat best en caning eabev and ttedproanydoes n. discriminate <br /> aaodibecsh iremIo nenttbased en en,cloampeomnalengiort,andtirWtie agaN:awm oanbgtheaaeve bted properly does not <br /> b memberhip orampbgmatit based on ace,ab6 or nominal txlph <br /> sign ALA //►/J////� _q e l! 9/lb <br /> here,mthorsd Signature / " ' 9 Yto f:Dy <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> RECOMM ENDATION <br /> I <br /> `� lQ�d /'y'qS""'s �'� a <br /> ®APPROVAL RECEIIEE <br /> ❑DISAPPROVAL -- <br /> JAN 8 2016 O.Piplatura C —��—° —,"�� <br /> Dale <br /> I FOR COUNTY UWRD OF EQUALIZATION USE ONLY I <br /> nrf� • <br /> TREASURERS AOFFIGE <br /> ,fit APPROVAL • GRAND ISLAND.MS�,. <br /> Y❑\DISAPPROVAL a al <br /> asa a aeams Authorized by Net Rant Set.e77QOZ07c)and(q,en 1104.185,aryl 6041139 <br /> 98-253-2008 1 Stosisedes sa zssBam R.as0a1 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />