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-1-Orra_ ►mil' 308- 850 -x-/358 <br /> elker, —L Application for Exemption FORM <br /> I Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> GmEramgriamis <br /> •Read instructions on reverse side. <br /> Applicant's Name Type pe of Ownership <br /> The- C IAA)rc.h of J 5-us Cht cf / 11.r D <br /> co..rrn ❑Nonprofit <br /> Street or Other Mailing Address } County Corporation <br /> 7-1-2_ W tsk S ` Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> G rct.....-C -L-SJo.ti4 NE (04BPz0 I CJtiu.,.c,h <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tie Name,Address,City,State,Zip Code <br /> is In n p Ptaa.ns cta..I 14 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Ca .Jo Nate 2nO F 9XQTS£(,)3%A)02 G3yb !�I/n(�/zorj <br /> Exempt Uses of Motor Vehicle: `rte{ Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational y�Religious ❑Charitable ❑Cemetery ass Indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: �q,ES ❑NO <br /> his Tc0.1 ler 15 tq be, tA,Sea. to htau 1 <br /> If No,give percentage of exempt use: <br /> Ca P'VI 3ec_L' yor GSA Troop ( , % <br /> I his (s O ckar-Ltred O rg iv. t Lay( 0,, 5,.r tt, � <br /> f� Bo S �kts c-c' Aw.e_y-t c.a, tvt{U it I I.L. Cne-voIn 06 Je,,ztS C'.h.,et <br /> Under penalties of law,Ieeclare 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 properly does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign ,t I <br /> here •Auth Signs 0 Lxt MA$�tr' ��2,ci Q J <br /> :CO Tiile <br /> FOR COUNTY TREASURER RECOMMENDATION l <br /> EriPPROVAL RECEIVEliorNit: N•; at 7.2 ao- <br /> ❑DISAPPROVAL � •. <br /> FEB 2 2017 =7 of jel- `�?i '-,—/7 <br /> Signature of C my Treasurer Date <br /> I MALL courant R COUNT) BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> PAPPROVAL GRAND ISLAND,NEBt4�: <br /> T❑DISAPPROVAL <br /> Authorized Signature r Date <br /> Nebraska Department of Revenue A„m„n.•n ry nor,°e"f,-.55" O2(')(.�a (Jy,and ee 1,4 wet o6 9,,,.9 <br /> 9.+e30-euuo Nev.0-dull bupersedes Yb-2b3-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />