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020 / 7 <br /> IlftenLZ 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 /> BIKES AND TRYKES OF CENTRAL NEBRASKA ® Nonprofit <br /> Street or Other Meiling Address I County Corporation <br /> 3004 W FAIDLEY AVE HALL ❑Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Prosr,dtn4 1Thutd An&retot zei B SiYea:1' Skit,,,, Jill iogob <br /> 11;ce PresetJ— Salem &a• ow'. 204 E. SErok She.14o,+ AA bWSJ _ <br /> Ste, 116,m Phtnnr 3444 c Shady Be R.a 41,11' 0 01 <br /> -if eAs. Vir5,1 KIUn 1 I •01 P she Ado,. tor,PE (08401 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number I Date of Acquisition, <br /> if Newly Purchased <br /> RC TRAILER 2012 7X16 TRAILER SRABE1624CM511451 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications ewst: OYES ONO <br /> W-Q,..Ufa- c. 1Wn !fit44•T 1/41 arcs 24-�.0G - a No,give percentage of exempt use: <br /> We �rautid} VAp ,� +r1kt$ CorliS0.6k a deagren and a ifs• Inc % <br /> NA_ --yo.•\er w,\l b<. .;scd hat..\ Ip.Ifts Va Milt 11 s' <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 property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign Q o - ‘)f 1119 /t'6 <br /> here Authorized Signature Title Date <br /> pr FOR COUNTY TREASURER RECOMMENDATION445:45-- <br /> APPROVAL REC�IVEoUMMtf,IS: �' At-c-, �� � <br /> ❑DISAPPROVA_ 1`LL�� ,s , <br /> NOV 1 4 2016 �' cd� ` 6 /8-at /6 <br /> Signal my Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND,NEBRAWS,Aaacas5; <br /> ❑DISAPPROVAL 7 <br /> •r orized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-209(1)(c)and(0,and 60-3,185,and 603,189 <br /> 96-253-2006 Rev.0.2011 Supersedes 964532006 Rev 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />