Laserfiche WebLink
Illren----Z— Application for Exemption FORM . <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name \ Type of Ownership <br /> *` e c c So•.`1/(h..k• o14 A-r`'y•y gi Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> Cl t O 3 SAT' 1 t• ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> �s u +.� c wP 0 se o T AiN <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Core OV-4J cz.r Major C'inadrtaYoc.AC W11815 $o, c'-n/ CI-Cvra.,Pts L.,.0, NE 627841 <br /> Qc.Jcsr Dior ..-4-7� !_Z/ S- ...c•-rt,r#. ��?sb.J ,a 4 2103 <br /> � y 6° <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> MotorVehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Nee Purc sed <br /> 1d-1, .da �0/4p \nfojor SFNRL5WgialG0.min t&1 a3 gib <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational VI Religious ®Charitable ❑Cemetery as,indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: Civw.r-c(, rc_ 'r 5 L+ ES ❑NO <br /> a.wQ- Cow•-n-.•-••-•4-y 4. - S r C'rt S 3n - e v o...-I-S lo.. <br /> r If No,give percentage of exempt use: <br /> 47 ¢Ver..,-Ti_ <br /> Under penalties of law,I doctor= ave examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that I •u, au • -d to sign this exemption applicat ion,and that the organization owning the above-listed property does not discriminate <br /> in membership empl• eased on race,color,or national origin. <br /> sign �n <br /> ' ` nil`ftj or /a// <br /> here Authoriz-. igneture �iNQv--LGS yo[kT-el The Date <br /> to <br /> COUNTY TREEAASSUdREERR.RECOMMENDATION <br /> -,S <br /> VNSV�JS3N'ONVlSiG ME .r.� 11" rye ' "5. '7 ' P° ' <br /> E APPROVAL 33 0 Sei3LIns`a <br /> Alamo TTVN <br /> ❑DISAPPROVAL /� <br /> 9t0? 8 333 �. �t -�-,0--i /.7 -0F..7- <br /> Signature of County Treasurer Date <br /> II FOR COUNTY OARD OF EQUALIZATION USE ONLY <br /> APPROVAL (v' <br /> ❑DISAPPROVAL '• <br /> faigiirr it et Ana.," ice-xi-4h <br /> Au ieorized Si• atwr ' Date <br /> ',ca Deportment of Revenue Authorized by Nell Rev.Stat.§§77-202(1)(c)and(d).and 60-1185.and 60-3.169 <br /> 06 Rev.6-2011 Supersedes 96-253-2006 Rev-5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />