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0901 7 <br /> +,^,--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 aide. <br /> Applicant Name Type of Ownership <br /> YMCA <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 221 E SOUTH FRONT ST HALL <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> rC a rii�irem� / 4 vie_ Or, /� rf � <br /> C. c,' Srcr t%r�.t f/ 'l gsnn 2320 'a,koe , • • G71�eS 'is ,_< a • oa r <br /> C a 0 yi., Zto // ,t.�fr _.. <br /> / DESCRIPTION OF THE MOTOR VEHI/ES <br /> •Attach an additional sheet,if nece _ary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year I BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> FORD p73 1083 VAN 1FBJS31H2PHB51071 <br /> FORD 1992 VAN 1FBJS3IHONHA98998 <br /> HOMEMADE 1990 TRAILER <br /> °F6RB"-- —20t5 —VAN— -fPBi9EfiEMXFKAS7AD8- <br /> Exempt Uses of Motor Vehicle: as-,, Are the motor vehicles used exclusively <br /> ❑AgriculturallHorticultural El Educational ❑Religious ?t Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: 121 ES ❑NO <br /> /41//104.47) s �l d Gcr I't A Cdre f- e-i• -S� / <br /> • If No,give percentage of exempt use: <br /> te !ham ro i ize Ato,f '-s //, c % <br /> Oar ,� <br /> mil tied Ave <br /> Under penalties of law,I declare that I have 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 am duly authorized to sign this exemption application,and that the organization owning the above-listed properly does not discriminate <br /> min membership or employment based on race,color,or national origin. n <br /> sign e,___ Rtc pars J2i'rn -- ?7p/?oe''Authorized Si nature Title D <br /> here 9 <br /> FOR COUNTY TREASURER RECOMMENDATION ' �/ +y <br /> 1P-APPROVAL .,..,a . riduni O'� ".O�k/ AteC.v / 7- 0-2- <br /> ❑DISAPPROVAL RECEIVED /_ <br /> NOV 2 8 CUIJ Signature of Date <br /> FOR COON BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE.�.�.�.�EN <br /> ❑APPROVAL GRAND ISLAND,NEBRAYPON <br /> G ND IS , <br /> ❑DISAPPROVAL <br /> Authorized Dale <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />