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Mt aka Delnranenraf Application for Exemption FORM
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be filed wah your county treasurer.
<br /> Q-•- -2=1 •Read instructions on reverse side.
<br /> Appli s Nam�19.I �) y, ���i ,/ ^,n �J� /�/�/� Type of Ownership
<br /> ru 1.++ I Y! (tk 1 sti l t.--4'r„"`^ r ❑ Nonprofit
<br /> Street or Other Maili'ng�Afidd CoHall nty Corporation
<br /> 14 !op VV t i��r t4 - - -7., ❑Other(specify):
<br /> Chy, a ) cs r-O SI�A-' Zip
<br /> Ucgo / State Where Incorporated
<br /> �(' rrnU^I' IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> 6kLar5 chairman rry c 6t 4esf 2510 Packview L1". (arafrslafiici ti) r gin
<br /> 'uic.v.-rte 1"WrUcc S'V3-7 Wi lU ll egVilmaWge l Nit 10E6,53
<br /> zGettar"i ,(�elrirY cgrtfvn-&tit 1Jv4© N.T�radfCinavOS-5JRnd Ne rv68b3
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,If necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make ModelYear BodyType Vehicle ID Number Date of Acqufshion,
<br /> it Newly Purchased
<br /> .1keThaIS Zcol 3(A5 i11Artl BWsk 4.04553 q-is—go
<br /> •
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricultural/Horticultural ❑Educational $Religious ❑Charitable ❑Cemetery as indicated?
<br /> GNe detailed description of use,including an explanation if multiple use�classifications�exist: (� //�r/�y/� `� FIVES ^ In NO �(/pry
<br /> \$CLE II.NIif ilrlit �7C -`ir r 10f 'pid TI'+ wr/f fcu r No,,,give per tisED
<br /> yfe rs_vi, hoofatf; le rT2 j also be i, d - %
<br /> l ,IrllPk- pt.,i MSi W es ail l-ki r-a G C isfi a r1 MAY 2 6 2016
<br /> Ck,u ci^.
<br /> WALL COUNTY
<br /> vsf +•SiU"_`� -
<br /> 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,cam sag pq(rept b p;E?RASKA
<br /> also dedare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed wegoitylh.cb,,,.t Jr•..rin,hwtr
<br /> in members" employment based on race,color,or national origin.
<br /> sign ire jiat. �:rs. ± . G1cer (re rman y-28-itp
<br /> here Auth::zed Signat i_
<br /> — TNe Date
<br /> l FOR COUNTYTREASURER RECOMMENDATION �i
<br /> ©1 PROVAL COMMENTS: "'�"— ,""` /11-4C-57 77_9Oc2-
<br /> ❑DISAPPROVAL
<br /> •/^l� ���dt ,..4--- CPd
<br /> •Signature County
<br /> Treasurer Date
<br /> ,,,���rrr...,,, FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> . APPROVAL COMMENTS:
<br /> `❑DISAPPROVAL
<br /> , .
<br /> ,// _ _ A_ / - _ /ii 0//...
<br /> Signature / Date
<br /> J
<br /> Nebreslm Department d Revenue Aulhmted by - e/Sbx.§gT?-202(1)(e)and ld),and 60-3,185,and e0ii,189
<br /> 96-25592006 Rev.8-2011 Supersedes 96-253-2006 Rev.5.2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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