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• <br /> TO BE FILED WITH Application for Exemption FORM <br /> YOUR COUNTY from Motor VehicleTaxes <br /> TREASURER by Qualifying Nonprofit Organizations 457 <br /> •Read instructions on reverse side <br /> Applicant's Name \ 1 J ` `(1� //'� ���`^ County 1 1 /� Type of Ownership <br /> a ti JI``TAAL,AT. les I TT V re L\iu&Le, L .- T1 Pt 1 , IR/Nonprofit <br /> Street or Other Mailing Address County Number Corporation <br /> Om180t} Sntik c S4r e* l0 'kojt 18(03 ❑Other(specify): <br /> Zp Code State VIMe Incorporated <br /> ( ",raM 1,ThlOtlnck_ ILDr- _ 10 gY,aa- NJ - <br /> Identify Officers,Directors,or Partners <br /> Title Name,Address,City,State,Zip Code <br /> r� 1 <br /> Per n 1 3(k pd . <br /> UST SPECIFIC DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach additional sheet if necessary <br /> Registration Date or Date <br /> Vehicle Make Model Year Body Type Vehicle Identification Number of Acquisition If Newly <br /> Purchased <br /> e ies/co\e•4 �oa9 t-E FA IR 36ura twvXgS tta,aq In / to/lip <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> O AgrtoulmrelMorticultural ®Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Owe detailed description of use,including an explanation it multiple classifications exist .,YES ❑NO <br /> ,• ow, • s. •r • L a • ere • •Aws• - " S ti +. Si If No, ve reenta % <br /> 9 Pe ge. <br /> I used �frrf-+ nV e teln4- � <br /> orVIA-t -e artl <br /> t <br /> Under penalties of law,I declare that I have examined this application and,to the best of my knowledge and belief,it is correct and <br /> complete.I also declare brat I am duly authorized to sign this exemption applicat ion,and that the organization owning said property does not <br /> discriminate in membership or employment based on race,color,or national origin. <br /> sign Ant ' S. w 0 PO here Au adzes Title -_f2 <br /> FOR COUNTY TREASURER'S RECOMMENDATION <br /> ���, ,r� 4/ . 7'7-77 <br /> �ygppppyp,L RECEIVED C0111MENTS: A!�"""5/ <br /> ❑DISAPPROVAL OCT 1 2 2016 <br /> M I i oiUvO !p 61 <br /> /o-/4-za <br /> Signature of County Treasurer Date <br /> WALL COUNTY <br /> TREASURERS OFFICE FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GKANU ISLAND,NtlditAbItA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL LeAl 1 f <br /> AwArrion <br /> RTa Date <br /> r ire <br /> Nebraska Department of Revers u Authorized by Neb.Rev.Stat.§77-20211 Xc)(d).§&J.185§W-3,189 <br /> 95-2542006 Rev.52009 Supersedes 96-25-2006 Rev.11-2006 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />