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Jul. 14. 2016 4: 15PM No. 1927 P. 1 <br /> r6;t• 34 E - 3 8 I f y'U4 <br /> wen.---4— Application for Exemption FORM <br /> Na.aa[a ceprlmant of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations?, <br /> •To be filed with your county treasurer. <br /> •Read insuuottons on reverse aide. <br /> M� t( ``9q r rr'' �`ty-�. )/ 1 Serene d Ownership <br /> I•ltl ije srockcw tnIiQi1a&1 Serenecs County � Joorproraion <br /> stoat or Olher Melling Address I ( (� <br /> •Z$'3 4 1.tin be L 6 n /'k u @ '1-1.11/4 ( ` ❑Olhef(seedily): <br /> City State Op Code " ' Slate Where Incorporated <br /> C.rasari ( s(ca NE 64ii's.0 3 ME <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> The Name,Addrese,Ohyt Slate,Zip Code <br /> MailraMi IA C, N rra s z4T,- 6 l 1147.2. <br /> IIEWA A iii! ra FCC am; • <br /> c Ea Dia,ta coy“( Zrb I ferkwet ic Pay, ..c.,£ 6 - 40 <br /> . • DESCRIPTION OFTHE MOTOR VEHICLES • <br /> • •Attach en additional sheet,if necessary. . <br /> • Registtatlan Date or <br /> MotorVehlole Make Model Veer Sedytyp• • Vehicle lD Number bate of Acquisition <br /> II Newly Purchased <br /> tar 4 .. Jo la{ • K 4r e r ea.h. 1 Pr X.Z g" FG a•keo 7Y z 3 . <br /> G - f4 - fb <br /> Exempt Uses of Motor Vehicle: • Are the motor vehicles used exclusively <br /> ❑AgricuNUrayHaracunuMl ❑Educstbrxal []Religious gg Ctwmabfe ❑cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation N maniple use classiacauons exist RYES ❑NO <br /> ?sV ,o..ZAI•, r'•e.po2 `, caw+Strttief+‘on ?mat & I Receive percentage ofexerrptuse: <br /> awd Yro•rnspoer r;tllel•')ueditjif wt our- _lax <br /> Under penalties of law,I decare that I have examined dyer epprcatim std that it Is,to the best of my knowledge and belief,true.melee,and correct.I <br /> Wee declare that I am duty authorized to sign this exemplicn application.and mat MNo ganlaatbn owning the aboxe•listld property does nut discriminate <br /> In membership or employment based on race,color,or national origin. <br /> sign W �,,y►+,�a , A Ana Df� 7/ft#/i( <br /> here ,3 as -38 5 . S'77s Tee °a1a <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> 24PR7VAL RECEIVED COMMENTS: 4v AISS 11 A la <br /> ❑D1SAFPROVAL .—. <br /> JUL 1 4 2096 <br /> �� rea��. diELla4 li bier <br /> M .4. "Hd Conty T surer Date <br /> I HALL COUNTY FOR CO INTY BOARD OF EQUALIZATION USE ONLY <br /> Tret,SuRcRS airrteC <br /> GRANO ISLAND,NEBRASKA <br /> 9AFPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> //AV i,,,„/7 705, 11 <br /> 7.115....°r a 7 — • r Date <br /> Netxeaye cepanmrx el Rumor Sheered b y Neb.Rex cwt$§77-202nxe)ana ld.and a0-3,CMS,end so-s,16o <br /> 98.2584005 Rev.84011 Supersedes 56259-2505 Rer.5405 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />