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TO BE 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 /> Applicants Name County i Type of Ownership <br /> t <br /> 1cAne5 DF l 7[ 6� 1d S �n/ i � lielqonprofit <br /> Street or Other Ma1I`g Address County Number Corporation <br /> 1 OO`t Sell `-, T' `d te-1 Pc R o s t 1(Jco ❑Other(specify): <br /> cry�rartc i XS fiAlt 1\1 t3& ? ap State Where l�rpoaetl <br /> Identify Officers,Directors,or Partners Zoo. �f�`J� G� <br /> Title Name,Address,City,State,Zp Code <br /> Pair A+AcbieA , <br /> LIST SPECIFIC DESCRIPTION OFTHE 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 /> 0 hry51er aooE 4.--\cbrtnn tt3Lf 51,FS4fi,a 512 to/It/ho <br /> • <br /> Nature of Use of Motor Vehicle: ,�,/ Are the motor vehicles used <br /> ❑Agricultural/Horticultural L_VJ Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Give detailed description of use,including an explanation it multiple classifications exist: (ter FS ❑NO <br /> Used. or- Q SC kt f� t1 r 0 ft 43K t a TlDMe_ CA t1L[Ors. H No,give percentage. % <br /> L as _ a t-a . .II lb r arl% -_t s 4 <br /> n rd 1-1-n..i r1 t r\q• <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 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 0 k 10Iit \ lk > <br /> here Authorized Signatu - Title Date <br /> FOR COUNTY TREASURER'S RECOMMENDATION <br /> 'APPROVL RECEIVED COMMENTS:" 1- A'J A "� �'9°' <br /> ❑DISAPPROVAL <br /> OCT 1 2 2016 �ay�� /®-.49-id <br /> •Sgnatureof ntyTreasurer Date <br /> MALI-COUNTY FOR CQINTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND <br /> APPROVAL CL7IOI�AENTS: <br /> '(❑'t DISAPPROVAL <br /> /40FP I- nit---(‘ <br /> '" :t^ISirr Date <br /> Nebraska Depanment of Revenue Aulhodred by Neb.Rev.Stet§77-202(1)(c)(d),§60-3.165§303,189 <br /> 96253.2006 Rev.5-2009 Supersedes 96-253-2006 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />