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Seo. 9. 2016 9:31AM No. 2495 P. 1 <br /> raten.---z.--] Application for Exemption FORM <br /> Nebraska NUE from Motor VehicieTaxes by Qualifying Nonprofit Organizations n <br /> REVENUEbe Sledw h your county treasurer. 457 <br /> r Read instructions on Warr.side. <br /> Applicant's Name T r [ 'type of Ownership <br /> MIA. ��abn0.5 km. :.r. UVrr( Ast JE�Ui4e C ❑NcnproAt <br /> Street or Other Mailing Address ?1 /� Couny Corporation <br /> 253 L ;'nx-k Car. 4U� 14a (l ❑Omer(apedty): <br /> City Mlle zip Code Slate Where Incorporated <br /> antral l sie..,.i Nz 6 s80 3 N E <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION • <br /> Tee Name,Address,Cay,Slate,ZS Code L 7T7•_ <br /> 'LAM . �� go <br /> • IIC� !� - I a . <br /> r rnrelerE • <br /> • G t=0 0164%c . f64..fi MI r. _ • tvts5 C • B eS, d 1 <br /> DESORIPTION OF THE MOTOR VEHICLES <br /> • 'Attach en additional sheet,if nec saery. <br /> • Registration Date or <br /> ��Motor/eh/lde Make Model Year eedyType - Vehicle lD Number if Newly Acquisition, <br /> C✓hrr1Sl`es- ,Lo ir Traakr— 2 C..4RC1066FF6Y '1'fl f74. -t <br /> _.Shot•'?^ Item. <br /> Exempt Uses of Motor Vehicle: • Are the motor vehicles used exclusway <br /> ❑Agdcollursldbrlk:unursl ❑titluCallondl ❑Religious (N CMrAabte ❑Cemetery <br /> as indicated? <br /> Give deUded description of use,Including an explanation it multiple use eleeeleaeiana exist: / <br /> 01/2YES ❑NO <br /> Moat s e rt 6 e V�(a(O WI en tat s Co(1 5 6 0 c:e A if NA give percentage of*carnet use: <br /> kA1v i k i,t.s..ls ea-,AS prouiale 5tryice6 <br /> For ahtiiptozeyle— rtr. <br /> Under penalties of law,I declare Thai I have examined this appdeatlon and that it is,is the best of my knowledge and beset,true,complete,and correct,I <br /> also dealers that lam duly authorized to sign this exemption application,and that the orsenizaeon owning the abovelisted property does not discriminate <br /> IA membership or employment band on race,color,or rational Cr*. , <br /> sign � 9i._ QlT> ra a --!15 I - <br /> here 13 Au 2edMkpatva ��idle <br /> I FOR COUNTY TREASURER RECOMMENDATION 7 <br /> [ pPROVAi rnauOAFN S: �A—� . .. - 77°ao�a.. <br /> 0DISAPPRnAL RECEIVED / <br /> �'4j��ot P— a- <br /> S E P g 2016 / .cam <br /> Signature of County Date <br /> FOR COU Y BOARD OF EQUALIZATION USE ONLY <br /> gi HALL COUNTY <br /> TREASURERS OFFICCEE..,,������ME S: <br /> APPROVA. GRAND ISLAND,NEBRA9RA' <br /> ❑DISAPPROVAL <br /> Alto PA Signal r Date <br /> Nebreska Depanmaw of Amine* Aelhodaed by Ne Re.alai,of 77.202t1(tei and(0J.and 604,tS5,ande05,lee <br /> 95-2574x5 Rw'.14011 aupwsedn 963a8.eoae Rev.52009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />