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01/26/2016 r5:44 3083641555 NEBRASKA STATE FAIR PAGE 04/05 <br /> 20/6 <br /> Mbec'�+ O p ;, Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> riimezeinaira <br /> •lb be Iliad welt your county treasurer. 1 457 <br /> Appioe Name •Reed instructions on reverie olds. <br /> Nebraska State Fair Board • rya` r Own�Np <br /> Nonprofit <br /> Street orOlher Mailing Address County ®Corporation <br /> PO Box 1387 Hall <br /> Oily , <br /> State Zip Code State Whore Incorporated ❑;Od1er(specify): <br /> Grand Island NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> The Name,Address,Clty,Slate.Zip Code — <br /> See attlehed listing <br /> DESCRIPTION OPINE MOTOR VEHICLES <br /> *Attach an additional sheet.if necessary. I <br /> Motor Vehicle Make Model Year gn Regbt on Data or <br /> dylypa Vehicle ID Number Dale gigeisidon, <br /> Trailer — If Now Pure/land <br /> 2015 Cany-0n 4YMUL1014FMO17342 <br /> I <br /> •F,atr$Uses of MdarVehide: Are the motor vehicles used exciusively <br /> Si AgaculluraWkicNWrel ❑Educational ❑Reigious ❑Charitable ❑Cemetery as indicated? <br /> I <br /> Give deleted descd e,kidding Of use, en wq,Ianaaon if multiple use classifications exit Elves ❑NO <br /> This trailer is used by the Nebraska State Fair Board of Agriculture and Staff for the purposes d Nor Iwo I <br /> of hauling heavy pieces of equipment around the Fair grounds and picking up large supplies. g oftaee: <br /> 1 <br /> I <br /> UMW penaltlee of law,I declare that I have examinedthia apppcadon and that it tti to the best of my knowledge and belief,true,complete,and correct,I <br /> also declare that I am duly authorized to sign aids*Somalian application,and that the organization owning the above-listed properly does not diecrMMaae <br /> in memberehp or employment based on raw,color.or Wand origin. <br /> sign • . f <br /> . 1-lf'1 Administrative Assistant 01/26/16 <br /> here Fmk, r . :f=61���YYY Tide Date <br /> I ' FOR COUNTY TREASURER RECOMMENDATION <br /> [/APPROVAL RECEIVEDMMEN11 frpr.w.i Pvu Ala.U. i 91-4i0,9, <br /> • <br /> ❑DISAPPRovA, <br /> JAN 2 6 2016 • JU Llp <br /> Q[iran b�.Ew ate : /(v <br /> �� Sllplabra of CounlyAe Cate <br /> L TRCHALL CCOOS OFFPCJOUNTY)OARD OF EQUALIZATION USE ONLY J <br /> GRAND ISLAND,NEBRASKA <br /> ❑APPROVAL COMMENTS; <br /> / <br /> ❑DISAPPROVAL <br /> 10� r <br /> , ratura Data <br /> Nebraska Deparenemd Roerwe Authadeed by Neb.Rev.Sat ii natel1)1c)and IW.end 603.785,and 603,189 <br /> 90/2604000 Rex 82pt1 Supareedee 66563+200&Rem.52000 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />