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N' eke� p� o; Application for Exemption I FORM <br /> NUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> ginTsinmil <br /> >Read instructions on reverse side. <br /> Ap m's me ,; i Type of Ownership <br /> • r Ka -, ) r-srr ,, �raf;n �,�r� <br /> S titer Mat i Address gy,Cor p rate <br /> (� n9 r--. County / Corpora1 n <br /> • V U'x l 7 ! ^"I I ❑Omer(specify): <br /> C' r---- I S�3fa /r��Zjw/`C� /Statte/Where Incorporated_ <br /> > rroK i� 0 I�FY OFFICERS,DIRECTORS;OR PARTNERS OFTHE NONPROFIT ORGANIZATION i <br /> Title 1 Nam a, ..resss,,Ci/ty,SSttate�Zip Code ` <br /> C)l�w .y MI —n e / MiilZild ,1. 4 S '.t • _ 1 C <br /> i <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheaf,if necessary. <br /> i I <br /> I Registration Date or <br /> Motor Vehicle Make ModelYear Body Type I Vehicle ID Number Date of Acquisison, <br /> if Newly Pumhasecl <br /> I - <br /> 1 <br /> Exempt Uses of Motor Vetacle: Are the motor vehicles used exclusively <br /> ❑Agricultura&Horticuitural ❑Educational ❑Religious Charitable 0 Cemetery as s�'indicated? <br /> I <br /> Give detailed description of use,including an explanation if multiple use classifications exist Ly'ES ONO <br /> Lf s Y2 / " '^ col L C4 r U\ O P c (0-1 4. ,+�Ci 3- i�r ca ( If No,give percentage of exempt use:• <br /> l/ IO✓�s )l L�/1'J' /� Le O/t CI� I/ iLw'�11� 7 01f r "1 <br /> Ail en d'_ ( 4ei O' l— /f& J7t,. 30FleU.-3 ?JO <br /> 1 <br /> Under penalties of law,I declare that I have examined this application and Mathis,to the best of my knowledge and belief,true,complete,and conceit <br /> also declare that lain duly authorized to sign tNs exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> Q� 1 <br /> SI f� <br /> here 4 S Au ' gna ,—w/ Title <br /> FOR COUNTY TREASURER RECOMMENDATION J <br /> d q% a <br /> 72-APPROVAL COMMENTS: �1ti nT a 4J'�' <br /> o DISAPPROVAL RECEIVED <br /> E v ' /a-� /7 <br /> r <br /> n r 5 617 i Signature of County Treasurer Date <br /> J FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> }APPROVA. GRAND ISLAND NOESRASKPOMM£.NTS: <br /> 0 DISAPPROVAL <br /> /a--/a-i 7 <br /> Authc;Icetit, ......___±rized igJ Date <br /> Nebraska Department of Revenue AuthonzSdbyNec Raster 4f 77-20211)(0)and(d),and 603,fe5,and W5,M9 <br /> -96.2532005 Rev.8-2011 Supersacles 08-2532006 Re%5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />