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X617
<br /> 'tee 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 /> Appicam's Name Type of Ownership
<br /> ORPHAN GRAIN TRAIN ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 427 N SHADY BEND RD -GRAND ISLAND PO BOX-1;a5 ,51j HALL
<br /> pother(specify):
<br /> City 1�,,,/n State Zip Code Slate Where Incorporated
<br /> C th SfZ NE 4$9111 :1,9da, NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> B LIZAW44 r1?rn-n-'As GR Rrs aA-0 Zees i//e Topelta. Circle, ernND 5-6.4900, a/G 6 tab a
<br /> A 45.-r 64 rrin--f', 6'41y r.1sDcti ca srin re 4-u/ Rd, 6s id6 ceAro/
<br /> Si. ecs-e4a,t AC,PrKU it cif, ca
<br /> ss'�_0 LWi!lsci, BAL'e' 4'?i.L /KG 6tys 0
<br /> scJrer P I.rz,evbe,-ihc 52'r+rK, ea% IC 1_,. /D Aie 4,trot
<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 /> HAULMARK 2006 UTILITY TRAILER 16HCB10146H14196T
<br /> CHEVY 1999 1500 PICKUP 2GCEK19T1X1246931
<br /> FORD 2002 F350 PICKUP 1F1SW30S62EB39517
<br /> MIDDLEBURY 2010 TRAILER 5RABE1010AM504932
<br /> LOOK 2012 TRAILER 538T162YGA004238
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> El Agricultural/Horticultural ❑Educational El Religious NrCharaable ❑Cemetery as indicated?
<br /> Give detailed description of use,including an explanation If multiple use classifications exist: OYES ONO
<br /> b5se.D t P-0.1 r-ei-arR.1s"iA/V e. rVJI,Z'1ems' ,a-,J4)
<br /> C,e Lke i V, c i.0 9-- i At,9 , ,,� 01 2 ryi c c..Z - C' a A9 C,..Y/ ° 1� if No,give percentage of exempt use:
<br /> ,'M Cesui-ra-1. rit! C,ne. IR oCK ALS° c's¢n rc"- %
<br /> cs id,Obis.,-Y a F 4 I sa r 4 e -
<br /> G'eAPfRcr - GfrAy csf 6c- V\ Rag —fb�b._ o� s3
<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 coned.f
<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 • pkryment based on race,color,or national origin.
<br /> a
<br /> sign .-l'" ,/r % —_ 11-a9-id
<br /> here Authorized Signatu r Title Date
<br /> FOR _ • Il TREASURER RECOMMENDATION
<br /> •
<br /> L{'APPROVAL RECEIVE MENTS £ 9%, — ,aA "1/-a- e77 -q
<br /> ❑DISAPPROVAL
<br /> NOV 29an°
<br /> watt I`l1UM1'Y !
<br />
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