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ooi7 <br /> �en..----z— Application for Exemption FORM <br /> Nebraska Department of <br /> 1 REVENUE nu 0 9 <br /> alrft Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> 'To be flied with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicants Name <br /> Type of Ownership <br /> NEBRASKA STATE FAIR BOARD ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 501 E FONNER PARK RD STE 200 PO BOX 1387 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> • <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 4Cet a4Fnr.ke ( 1 i G4 4.3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body7Ype Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> CHEW 2012 PICKUP 1GCOKVCG1CZ20065 <br /> CHEW r� 2004 SEDAN 2G1WF52E849247415 <br /> megy 2003 PICKUP 1GCEK14T53Z276748 <br /> CHEVY 2012 4 DOOR 1GNKVGED5CJ296041 <br /> CARRY ON 2015 TRAILER 4YMUL1014FM017342 <br /> Exem Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> W-A <br /> Agricultural/Horticultural Educational 0 Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: t )(YES ❑NO <br /> 1 Nt. acros.pcuAy VC�tfr lGS are-tAsed loy !J cfhASkt S+0.-lc. Pot-or <br /> je <br /> /i ! / If No,give percentage of exempt use: <br /> d. i�c for +kg- AW pCSCS 0-C Mitkettett YMC.C.411St % <br /> 4: <br /> Cownovts d.. pi6164�{ uu4 Suppl; s- J <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 C . t ion appl "/ <br /> here Authori z 6 j:ture r/ +i1 D0Br`GI'I 302— sag fide /&20 Date <br /> ,� IlG!/ FOR COUNTY TREASURER_REECOOMMMENDATION <br /> LvJAPPROVAL <br /> RECEIVED......-s: �-s-09j; - /- A.249.5(4.5. 77 ac Z� <br /> ❑DISAPPROVAL <br /> NOV 2 8 2016 164221 X& /--51,7 <br /> • Signature of f FOR COUNTY BOARD OF EQUALRA7ION USE ONLY <br /> MALL LOUN r Ir <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND,NEBRAS6OmMGVTS: <br /> ❑DISAPPROVAL <br /> Nhoraed Signalu `' Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.?i§77-202(1)(c)and(d),and 60-3,185,and 603,189 <br /> 98-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />