Laserfiche WebLink
Nebraska of Application for Exemption FORM <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 /> Applicant's Name _` /��^^ ,,//�� - - j Type of Ownership <br /> Ne�bRc�K.t, D-t9AP;L'F tolunc a , t+-t-1■v ry y„.u,es 04 &o a tl��-.rNonprofit <br /> Street or Other Mailing Address �^ ��yy ` County f 6 'Corporation <br /> (,0 Belt t ltoc (ito3 WCS* LV J' t- aa.t1 ❑Other(speciy): <br /> City State Zip Code State Mere Incorporated <br /> & ,v,-d Jsketsa..c� N-e1 Co2.S3aa NE <br /> • IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name.Address.City,State,Zip Code <br /> FRGCtdewi ELOG§estf (1.1 4..e. coca C 5te4 4kRec,+ PI KecsYA 9 NE (08gfl <br /> Ser.Relca_y/'rgc.csun.ca Teegl l3, Rowvx (9kiso Fe,c3[ove torte. LuN.catn NE (78 $ey <br /> DI,Rev Dik G c12-1 f-kyt 9-109 rrt+b eP,gacL c DR the f aptltbrt r■ E k2 S133 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> ( 11++��jj if Newly Purchased <br /> Ultt'a-te,o tc.ct(a trcte5[ia-cflnttta TD(3S cop 15-r1or}0tn83 . (o/f/ Ito <br /> Exempt Uses of Motor Vehicle: 1;t Religious the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational DsT Religious ❑Charitable ❑Cemetery <br /> as indicated? <br /> �-{Give detailed description of use,including an explanation if multiple use classifications exist: ,( YES ❑NO <br /> f V 'ts 4R.Gt.It-° Aw ll�a [[ be L'5 40 �L..vi �Ut ern' ca-J If No,give percentage of exempt use: <br /> rnctSe ,1dS 40 ©UR- Cca-"`P j tow...6s }s_ �..r X r1"54-o.,` N E { % <br /> ens Wa[ as awl Se�v,Ltc 6 P. S rec c t Wet+ r PI-5c ttti4 <br /> We (,ytt94,,(- kakte i A One a' by i O load CkvRzck-t S <br /> Under penalties of law, 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 d authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or em ent based on race,color,or national origin. <br /> sign O 9t� c>inu-t,vc.- Petsk-aR 1/i /[ L <br /> here ized Signature Title Date <br /> FOR COUNTYTREASURER RECOMMENDATION <br /> RCPPROVAL COMMENTS: <br /> / i�rt �ti �.S5 '�77"- 4d� <br /> ❑DISAPPROVAL RECEIVED <br /> JUL 2 6 2016 SignatdirCOT County Treasurer Date <br /> I FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL TREASURE 1F¢�q�NTS. <br /> GRAND ISLAND,NI=8RA3ll4 <br /> ❑DISAPPROVAL e / et / <br /> 1 -!r onz-.S.,atur- w SA") A" Date <br /> Authorized Neb.Re tat. 77-202(1)(c)antl a 0. <br /> 9-253-2 06 Rev 8-2011 of Revenue by v S §§ (d),and 6 3,165,and 60-3,189 <br /> 96-25&2006 Rev 6-2011 Sopersetles 96-253-2006 Rev 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />