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gsk� - Application for Exemption FORM <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 /> Applea'nts'Name(� D p Type of Ownership <br /> % i IViJ 0 `n-ter ) n t^ ❑Nonprofit <br /> Sfreef�01� Matting Addre�1Q Rd• F,Q 60X 5085 coth fa II Corporation <br /> ((//y�Jl,, /�✓G✓G I}�VI }� ff�(f ❑Other(specify): <br /> Cryy� rlNnd is [aT l d N 'e Zip Corte State Whe-ry Ir�prporatetl <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> P0, : , Tent I/ f ► • :• s14 c , I an "re T ,btio AM•tl / f - "I - Clad � !i G AtiLt4•0—.• 1 ir) , • G1 , a - f r40 - <br /> Fiat f / ' ! rev lam - " f,r - '0 :DX al (0 Saar i, t <br /> W t rfl r 2, 1 a 'MP - t # o i ►. APAIM�'Il �'lr(ilirO ifZ, -2o. et <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 Date of Acquisition, <br /> if Newly P rchased <br /> ors. . ► lrllanagia rs brile-fIc a.inirst xu to 5 in <br /> Exempt Uses of Motor Vehicle: �/ Are the motor vehicles used exclusively <br /> El Agricultural/Horticultural ❑Educational ❑Religious M Charitable ❑Cemetery as indicated?all <br /> alai d description of use includin an e donation if ulfiple use classifications exist: / <br /> ES ❑NO <br /> I f ' , ' / 1 trite / W tX , ' • If No,give percentage of exempt use: <br /> 4 1 ` 1 <br /> ' ' 0f <br /> it f . . s i 04 i 1 p u/Me a w <br /> .stn 1 VIA if 8��it,� C' , , a,4 d <br /> Under•-•-(ties of law,I declare that have examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also d: i that St duly authori•:' to sign this exemption application,and that the organization owning the abo>listed property does not discriminate <br /> in m: t• • .nployment•: :•on race,color,or national origin. ,2 DI —3e a-- 416 x1 G.1� <br /> sign � I eC'�� Direct c/ rIi7 <br /> here - thorize• ignature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION �S <br /> i❑APPROIIAL RECEIVED COMMENTS: £1' 9''t -'s l" n7 QO42-- <br /> ❑DISAPPROVAL <br /> MAY 1 8 2011 `� �' y 5 as�7 <br /> /Signature of County Treasurer Date <br /> NALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> KC <br /> I APPROVAL COMMENTS: -.. <br /> `T❑]DISAPPROVAL <br /> Authori•>• s <br /> ignature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8.2011 Supersedes 96-253.2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS, <br />