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O E FILED WITH Application for Exemption FORM <br /> YOUR COUNTY from Motor Vehicle Taxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> -Read instructions on reverse side <br /> AppGpant9 Name _ County Type of Ownership <br /> /Lj' Britt \t l l lnAudcnes 4 at-0_6A,, Ot\D a_S .sit 144\11 ,,--,,( <br /> Street or Other Mailing Address �( County Number �C Corporation <br /> 1 $a '-} S. E.dd,� S . P O. )O)& Ice? L3 er(spec <br /> C Zip Code, State Where Incorporated ❑Other(specify): <br /> m2scald lsl�nc 1 k . 1zStO- 1, <br /> Identity Officers,Directors,or Partners I <br /> The Name,Address,City,State,Zip Code <br />• <br /> Pe r A kpii- <br /> UST SPECIFIC DESCRIPTION OFTHE MOTOR VEHICLES <br /> I •Attach additional sheet if necessary <br /> Vehicle Make Model Year Registration Date or Date <br /> Body Type Vehicle Identification Number of Acquisition if Newly <br /> Purchased <br /> C.1-.1-tr re,lt-3- Aht inn I, hu_ I G%i ArNSLIOPFT7n175 o8/10/,to <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> ❑Agricultural/Horticultural ®'Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Give detailed Used of Inc.including an explanation if multiple classifications exist ®YES ❑NO <br /> used apr F1lCktA3 uc�n(�-k-akt Yin me c‘Can 4\\' ft No,give percentage. % <br /> Its€a sit' SI. vp9t-ri- yric 0It'es nr Ali iVtes anti. <br /> Under penalties of law,I declare that I have examined this application and,to the best of my knowledge and belief,ft is correct and <br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization owning said property does not <br /> discriminate in membership or employment based on race,color,or national origin. <br /> sign 40o/�� /y7 OF & <br /> here Aofhonzed Sign¢ a Title Date" f <br /> \VI <br /> FOR COUNTY TREASURER'S RECOMMENDATION <br /> APPROVAL RECEIVE MENTS Efi""OCtse J -.7,e,� <br /> IT DISAPPROVAL <br /> AUG 1 1 2016 C ripe j'Ci-a-RJt- et tr-vc <br /> • Signature of County Treasurer Date <br /> HALL COUffI9R COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFIC! <br /> GRAND ISLAND,NEBRASKA <br /> i.QPPROVAL COMMENTS: <br /> IT DISAPPROVAL dafi1, 47% J�fj.' az <br /> Authya, -.Si:f-, :ir- — /a � <br /> Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§77-202(1)(c)(d),§60-3.165§60-3,189 <br /> 98-253-2006 Rev.5-2009 Supersedes 96-253.2006 Rev.11-2006 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />