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qiii.eli-n— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> A �Iiiccyants Name J /,tom Type of Ownership <br /> 711M'1� rt�'Q-I10L Area-�t- 1�1 _� YID-fJLb1 tl C- nil Nonprofit <br /> S`���tr�rexext T7or Other Mailing Address r County Corporation <br /> JV4 We_Z✓1 cl.5-1-.b Pa Bt,%,1O0 I . 0 Other(specify): <br /> C,y Slate Zip Code Stale Where Incorporated <br /> l'Sr cknct_ I&ara , K1 E && O 2- N E <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address.City,State,Zip Code <br /> Pre stden.f" si Ue_ fYtarKvlitca , 21L1-o N . c.,}r-ktb-Z we b�3$o 3 <br /> VIcc-?re stden-t- Sara S s , 4O'14 11� w,hrl�co (7=. K3E bSr6b3 <br /> St c, .e vi r,'t-r..s' 'aft t t c 9 Lr v e v 1 e � C_ r t i GI OE_to s f;0� <br /> Tree SLLrear Darnel i�cr}-1-, r LFt 3 Pre Liot-,a Av-e- . C 4JF_ fRO 3 <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> (-7 M (t_ i qt q to c'U+tuv[u3\lctn(5 5Li0 i&C,i Gil ktrFKci le,3Q 5J2-5/i Lei (dcnaa-cf) <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 0 AgriculturavHorlicultural fl Educational Ill Religious ist Charitable 0 Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: RIVES 0 NO <br /> lA/tSc-d io pickktn,p CIcna}ecnsl-Fra,r)spci`f he me t rrtpro v^P_rn-vv4— And <br /> `.ensi-nA Cfi 0 ri nn&4e.fla_ks Gin a 't ra-e1sncr'r perscnne_t anR If NO.give percentage of exempt use: <br /> ?co CA IA.C+S in Pur-SLt+ co- ekrr [n oust n., rrrtss lc✓t . <br /> 1DI,t,L i-D tin e„ e e Of- +ruck, 11- mix t.) c-Fe r S-fur&sy_ c - so-`ct <br /> vnn +1 n-tc 'It <br /> a lerltLls fre i rx <br /> • <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,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed properly does not discriminate <br /> in membership or employment based on race.color.or national origin. <br /> sign . ,J - ,i/zsi/6 <br /> here ut orized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> g,APPROVAL RECEIVED CO ENTS: 'r�t'""f /21-A- ~ `5 �` -77 a , <br /> 0 DISAPPROVAL <br /> MAY 2 5 2016 �/_ "S .S aG-/lc <br /> Signature of ounty Treasurer Date <br /> HALL COUNTY FOR C UNTY BOARD OF EQUALIZATION USE ONLY <br /> i TREASURERS OFFICE <br /> GRAND ISLAND NEBRASKA <br /> APPROVAL w ENTS: <br />• <br /> 0 DISAPPROVAL /r " <br /> . '// / . ./AV ;5/bin-id, <br /> AuthorizT• ig ature / Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev-Stat.§§77-202(1)(c)and(8),and 60-3.185.and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />