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;ace <br /> te-L -_ __ Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be Bled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name <br /> Type 01 Ownership <br /> "c- )es e ci cl-e . s-.),>-s 6 b-e.7 e z.e r <br /> Street Other Mailing Address ( Nor p rata <br /> 5 02 C Co i '-I a 1 Au A 6 0 -X Y6 County Other(spen <br /> p ( e /c ❑Other(specify): <br /> City State Zip Code State where Incorporated <br /> ranci Islc6nd 1\E b 8 02, Alc-- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zit Code <br /> C-iDCP. C � t Ios par 4iiu l I I Lrc& it z-1 .eand f.sic.) Ma' 6f'yb1 <br /> c- tDt ( -� uan elonrede7 71 knit p aca U' xeid IseppI l 6-8%"3 <br /> & I 0-cc 2 u ?n Cs«n�n✓ :TOP e c'ar. kt y-Z 6 t ac() tsa tom.? ,.s- 6Ii'al <br /> 24 .S--1 be. c-Rrn..c Le f r 2 Zg2Y £kJiL-ii Av-e (4.4-1 LcA>..i A4, Ln'a'a3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> _ if Newly Purchased <br /> CkVItra (-ci 2 oP° dot ssey y - 7GANG39KZ9UGis/S /2_ i3-/6; <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> A riculural/Horticultural ❑Cemetery as indicated? <br /> 9 ❑Educational Religious ❑Charitable <br /> Give etailed description of use,including an explanation if multiple classiUations exist: pi YES ❑NO <br /> t /� It No,give percentage of exempt use: <br /> 1.vi C'r.v�-k f,rm —uv c� o ft.at Y its, Vileenl Li.cs end..‘ (-A" A <br /> 1 <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 ace,color,or national origin <br /> sign i -< _ c �� e_ -,,- �,, _ ov_/-7 <br /> here ,Authorized Signature Title Date <br /> FOR COUNTYTREAASUURRER�,REECOOMMENDATION <br /> APPROVAL RECEIVE^ENTS: £.% I nit e' frejtj 4S5 "77 2e)-2" <br /> ❑DISAPPROVAL <br /> JAN 9 2017 OP-Signature /yy�{�' 7-4/d--,7 <br /> 01 County Treasurer r Date <br /> I HALL COU11914C&UNTY BJARD OF EQUALIZATION USE ONLY <br /> TfCAQURCRS aurr'tOE <br /> GRAND ISLAND,NEBRASKA <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> /ice _� ' _AC/i- .-.( ._ 01 0/? <br /> Who zed Signal ally ;.ate <br /> Nebraska Department or Revenue Authorized by Neb.Rev Stat.§§77-202(1)(c)and Id),and 60-3,185,and 60-3,189 <br /> 96 @542006 Rev.8-2011 Supersedes 96-253-2006 Rev 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />