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) I) 1 <br /> Jur,� ;, Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be pled with your eouMy treasurer, <br /> •Read Matuotpne on reverse side. <br /> Applicant's Warns Type of Ownership <br /> YWCA ig Nonprofit <br /> Street or Other Melling Address County Corporation <br /> 211 E FONNER PARK RD HALL ❑Other(specify): <br /> City Slate Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE 66801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Tide Name,Address,City,Slate,zip Code <br /> `su_ O t 4I Qt%%1- . <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,N necessary. <br /> Reglelration Date or . <br /> Motor Vehicle Make Model Year Body TWWo Vehicle ID Number oats M Acquisition, <br /> II Newly Purchased <br /> FORD 2002 E350 VAN(BUS) 1FBSS31L32H635592 <br /> FORD 1996 E150 VAN 1FMEE11 H9THA65657 <br /> FORD 2015 SPT VAN(BUS) IFBZX2ZMXFKA87993 <br /> Exempt Uses of Motor Vehicle: tzt Are the motor vehicles used exclusively <br /> ❑ApdadlereMHonicettural L�1 Educational ❑Religious i'I Cheated° ❑Cemetery as Indicated? <br /> Give detailed description of use,Including an explanaion d multiple use classifications exist: (.li RYE$ ONO <br /> 1.-01tiz o c 4S Ofl c cki 1d.reym -c-veyn ¶ h oOt, au <br /> 4 If No,give percentage of exempt use: <br /> '75 9 -c;-, Spuc;s Q1 °QV C(L+'t- �J li 3-�c�iz.. 1'Ded) <br /> eirL.2ei4) <br /> Under penalties of law,I declare that I have examined this application and that It Is,to the best of my knowledge end belief,We,complete,and correct.I <br /> alsodedare that lam duly authorized to sign ads exemption application,and that the organization owning the above-listed properly does not discriminate <br /> In membership Of onployment base race,color,or national origin <br />, Si here �{j�� k c`" , ` �.+�c Xe� t �;� �i t e� w �� � I l�� l to <br /> here /AOttor 3,• , • .0 aa- TTdo Dale <br /> ✓MA S t 1 1y dP,? S <br /> e le-ECl— " tiz-1 / /5.41 At-77`-1e <br /> 9, . <br /> LAPPROVAL RECEIVE TS <br /> ❑DISAPPROVAL <br /> NOV 1 4 2016 ► iignaiure sun ,terms /e---5-7—/7 <br /> FOR COUNTY BU1RD OF EOUAUZATION USE ONLY <br /> HALL COUNTY <br /> ❑APPROVAL TREASURERS OS1TS: <br /> GRAND ISLAND,N <br /> ❑DISAPPROVAL <br /> 0'a.._e_ . _e.;�✓,� /—/a-i7 <br /> ulhodped SlgnMU .! Date <br /> Neon dm Department of Mane Authorized by Nab.Rev.Slat.1/2 77.202(1)(o)and(dl,and 645,195,and e0-3.1 e9 <br /> 95-253-2006 Rex 8-2011 Supersedes 96.253.2006 Rex 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />