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Nabr arDapammemur Application for Exemption FORM <br /> MEE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be Tiled with your county treasurer <br /> •Read Instructions on reverse side. <br /> Applicant's Name n Q �) 7°X/7--) /{ Type of Ownership <br /> (c g p/PA/t/ Erg,q-/!l� /l 4 )J ❑ Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> d' th /V. ,5 - V 8/4V2 7 AU //d,24901(..:93(6--- <br /> ❑ Other(spenly): <br /> City , State Zip Code State Where Incorporated <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ,8/n--,✓cll nmunseq Ic*icy mi.Ec K,c5, c .iraicBee/-cut /z.o, r; jL R'r h 'cce/ <br /> 5ecre'- nrry /Zo4' ff-Qatoes. , doX /S7 13G//Eteiii- /Vc 6 e 7 J 0 <br /> TOyaA6o c E/d _ B a-re4 ST ii.2ii/ _ B ax'/17_, -Cdrl/']-,v0 iv E: <br /> DESCRIPTION OF THE MOTOR VEHICLES <br />• •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> It Newly Purchased <br /> C {;eV /g'oa 4...X.i�1 /9/9 P1cJc..-n ,-,. ac £lO9Yocai 99I y ag -/e <br /> . <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ID Agricultural/Horticultural O <br /> Agricultural/Horticultural ❑Educational ❑Religious D Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: z7 �.NES LINO <br /> Cc); i( .�aa- used} cor c'o�./� ti ) l7o/u/��Iep GLoy 14.17 .6/A,N <br /> CD'a.V- .0 oa/1re.b -,.tmg /1fG RN-Arn r--S1-nut 0 Kr' e et. II No,give percentage of exempt use: <br /> 4 Under penalties of law,I declare that I 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 organisation owning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign 4�J�bl. S rrlcd- nnAls sex f}-a5" - <br /> Authorized Signature Tale Date <br /> FOR COUNTYTRE�ASUURREERR RECOMMENDATION <br /> Q CFP iOVAL RECEIVED COMMENTS: '�—" " 44- 4/air '2'7 P02 DIS<PPROVAL <br /> MAY 2 2015 ' c1 'J"& ,� <br /> Sign c unty Treasurer Date <br /> I FOCI COUNTY BOARD OF EQUALIZATION USE ONLY I <br /> HALLLOUN TT <br /> TREASURERS OFFICE <br /> rrn APrr-!AL GRAND ISLAND,.NEBRASKA r OMMENTS <br /> ❑DISAPPROVAL i/f /.y <br /> *f .. <br /> Date <br /> Nebraska Depanment of Revenue Authorized by Net.Rev.Stat.§g 71-202(1)(c)and(0.and 604,185,and 603,189 <br /> 96-2542008 Rev.6-2011 Supersedes 96-253-2008 Reis.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />