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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 Type of Ownership <br /> lska A t . d es 'e .. . . L.& v 4 J L I ❑Nonprofit <br /> Street or OOttherM 'dress County[ (}�J/� R ,� Q+y County Number Corporation <br /> 1 it n4 11-TY\ / €€e_4- 1 l J 1 X�X `& ❑Other(specify): <br /> Cay _c • Stales Zip Code State W rated <br /> Identify Officers,Directors,or Partners <br /> The Name,Address,City,State,Zip Code <br /> PF?c P.4-l=.r r e_ci <br /> LIST 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 /> IN\A77A 4r)1° I MA2hk to tYv LAPS I!>\e9 lc K0-12,5", toLdc/Ito <br /> _ _K eZrtm(o 1--u( erne I '4 14P.51/2.96 ti anaLa to/86/)lo <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> ❑Agricultural/Horticultural 14 Educational ❑Religious ❑Charitable ❑Cemetery exclusively as indicated? <br /> Give detailed description of use,including an explanation it multiple classifications exist: . j� VYES ❑NO <br /> U`]C11 �'pr 9u4C °c �r '�r7�Gl _ 'IYtP (" IiPJV'1'S. /'t1 If 777N0000,givepercentage:. % <br /> -brat ill fl. <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 /> here - ■`I ... . 'IPA E° Dater ro <br /> Jere Author. 3igrature <br /> FOR COUNTYTREASURER'S RECOMMENDATION <br /> Q�APPROVAL RECEIVEDDMMEN-S: - I - ..e.�• / `: �/ <br /> ❑DISAPPROVA. <br /> OCT 2 i 2016 I 1 Cl_ / ri 1r) c _ 4v <br /> • ' 1 10•- • <br /> igna - of County Tre:-urer Date <br /> TREASURERS COUNTPOR COUNT"'BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND NEBRASKA <br /> g-APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> /1SA/ iil43ii�:/./ <br /> Date <br /> Nebraska Department of Revenue Authorized by Nee Rev.Stat.§77-202(1)(c)(d).4603.185§603.169 <br /> 96-2532006 Rev.5-2009 Supersedes 96-253-2006 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />