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--L— Application for Exemption <br /> Nebraska Department of of ' pP P 1 FORM <br /> NUE REVE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be Bled with your county treasurer. <br /> •Read instructions on reverse skis. <br /> ApppArt's Name //,'� \ <br /> L t Type of Ownership <br /> UP-Ape A 6'n, On(n(in r �'r o5 Nonprofit <br /> StreeejJ�r ether M,a(il' Address <br /> ry County/ Corporation <br /> 0 7< J !y! / t <br /> ❑Other(specify): <br /> Ci State Zip Code Slate Wnere Incorporated <br /> Cep of ] -)°, a/' DYE ilkfU 11/1:7- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title I N. e,Address.City,State.Zip Code /y <br /> ✓b es c' , i r ce • . li i <br /> v c -�, (,v^, ,Par •W kcio _ seL5 deli or-, I` . l I,� � ^3la of 30 <br /> f� n - L✓ _. s w . . V. •-^f+, e-il R) fit. <br /> ' DESCRIPTION OF THE MOTOR VEHICLES ` C <br /> *Attach an additional sheet,If necessary. <br /> 7 Registration Date or <br /> I Motor Vehicle Make Model Year Body Type j Vehids ID Number Date of Acquisition, <br /> if Newly Purchased <br /> /i i</ )171 <br /> I <br /> Exempt Uses of Motor Vehicle: �,t Are the motor vehicles used exclusively <br /> . ❑AgrlculturevHorticultural ❑Educational ❑Religious pttihantabe [3 Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: <br /> Xs :NO <br /> Ws _ ,� A r'O°0-/".�j 0.4L.„ „,f r r s, ( If No,give percentage of exempt use: <br /> (. O' aP"'J7Ci, Q T C /dA I-, s, h•\ PPPstr CO ` 1!k. <br /> et <br /> 3 3v <br /> d0 in 4;u r S - 4:4 7,2,e.34,......_ .�o g ifO r 7 <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 discrimirste <br />• in membership or employment based on race,color,or national origin. <br /> sign C ice - C�. c '�-- a� /�-/5-1c)17 <br /> here Authorized Title Date <br /> T R RECOMMENDATION <br /> { <br /> FOR COUNTY REASURE i <br /> i <br /> [PROVr t wM`AENTS: n/'/`� ` AzAL ' " �'��� <br /> ,n.DISAPPROVAL RECEIVED <br /> NOV 1 5 201] `�l to —5C7,7 <br /> Signature nature of unty Treasurer Date <br /> I FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> QJ APPROVE L GRAND ISLAND,NEBRASICA flMMENTS: <br /> 0 DISAPPROVAL <br /> Authorized Signe app" _ Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet 64 77.202(1f(e)and(d),and 80-3,185,end 80.3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2008 Ren 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />