|
..,.•--tom _--Application for Exemption FORM
<br /> Nebraska REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be tiled with your county treasurer.
<br /> •Read instructions on reverse side.
<br /> Applicants Name �1 / /gyp " Type of Ownership
<br /> l Stc r5 d'T At Hasa �t+y o prt4rVr Nonprofit
<br /> Street or Other Mating Address /� ! County ®Corporation
<br /> 7 /..a t a, t;eu f3Ue- k cell El Other(specify)-
<br /> Ciry _ Slate Zip Code State Where Incorporated
<br /> G��Md> S L„.4 /le L f l3 11:k
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title !l Name,Address.City,State.Zip Code
<br /> S:s'l'zr 4c-an TALI / at-,Pi v—e-z.s;cFc 4- Pu, Rox 313 Koerrlrcen &.D, i i I a N[A.ri L PA llo i 4:5—
<br /> DESCRIPTION OF THE 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 /> I) O'TCt. C me t[0 .9x)i rc f-j 4>oa to Re ELT,Ci kg cot l>c 4s L w>s' 674114,
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ID Agricultural/Horticultural VO Educational n Religious �11 Charitable 0 Cemetery as indicated?
<br /> 'Pedetailed description of�us/e/�,incluy,ding an explanation if multiple use classifications exxiistt: �) .,�L f o I YES ONO
<br /> 'P1 'e car IS u5ecP -for IQh�-oral 1 ites%uS+r,/y� );,,,-ilalr `"(/e SILK. .l ciao`is pr�lJ 1 K�
<br /> f n:J -Irk e- CC a S 0 iR Ti 0 vs CC- th0— to jar i 3"1 4-ii t.+ l(h V10,--;r h0^,epL, [gyp'+ f [ dt• If No,give percentage of exempt use:
<br /> {o CI et kt itstc-+ie 4 Nk-4-ic.pa Tl nj tat E.,�0.rc ;Ca. ruicG; ,,,,- ,,, tiOL4 % to
<br /> fil J.
<br /> clue c..+;0.x class cs 4-- nr r-.aefn,.j -`l•e- kta=cc CC-pc,{st'a1S requ sbtKC,
<br /> p (� j U J
<br /> act"c‘f 6v�x r e • 4LT•2. gILe-[fer- Cce net ta�iV , e..2 •r..sfe07 e- ,
<br /> t [f
<br /> Under penalties of law.I declare that I have examined this application and that it is.lo the best of my knowledge and belief,true.complete,and correct I
<br /> also declare that I em duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate
<br /> in membership or employment based on race,color.or national origin.
<br /> •
<br /> sign , DcN 2 r�.n:1. 1t-t r1r��w 4, 7///20/4
<br /> here Arithonzed Signature V Title Date
<br /> FOR COUNTYTFEAS SUUR,E�R/R]ECCOOMMMENNDDATTIONN �, �i
<br /> [I�PPROL7h. RECEIVED COMMENTS: •'r eintl �`t " " $4 / 7r�®�
<br /> 0 DISAPPROVAL — ��pp
<br /> JUN 232016 U! ea rc
<br /> Signal nty Treasurer Date
<br /> FOR C)UNTY BOARD OF EQUALIZATION USE ONLY
<br /> HALL COON i9
<br /> TREASURERS OFFICE
<br /> 6drAPPROVN GRAND ISLAND NEBMENTS:
<br /> r0 DISAPPROVAL '2 1
<br /> Aur!ized Ignat.re Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§9 77.202(1133 and;dl.and to-3,195,and 60.3.161)
<br /> 96-253-2006 Rev 8-2011 Supersedes 96-253-2006 Rev-5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
<br />
|