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�- Application for Exemption i °OR s
<br /> Nebraska Department at
<br /> NUE REVE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations
<br /> •To be tiled with your county treasurer, 457
<br /> •Read instructions on reverse side,
<br /> Applicant's Name .Type of Ownership
<br /> CENTRAL NEBRASKA HUMANE SOCIETY IYI Nonprofit
<br /> Street or Other Mailing Address County I ✓C Corporation
<br /> 1312 SKY PARK RD HALL
<br /> Other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68801 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code___
<br /> ArQ ££e �f-ra.s.e. — 131( Si i Pak- —/P-F6-r t-1,.w 6yf7?6/
<br /> SI er /Iluha M C 6,-ve5 ' /31 Z S ar r, .i .Ne 6&-k0!
<br /> 3 rf . _ - s f
<br /> ere u4iVe�9 r zg4Y ���Sc :<.: / / S P
<br /> ��ll 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 /> It Newly Purchased
<br /> D. t (• ,. ,.a n ll- 2 0 u - __ tam Fn i 21 /R i 52• ' a 2077
<br /> exam w 0 ` /a� I S 126 2 �3� ,.
<br /> _ ._
<br /> .& / k k' FZZB29:_ / i 7
<br /> nc ,_10011EM� Ta .
<br /> 5 ; . 9U ' I t C. / _016
<br /> 1
<br /> Exempt Uses of Motor Vehicle: w Are the motor vehicles used exclusively
<br /> 0i AgriculturatMoraculturat ❑Educational 0 l Religious k'Charitable Q Cemetery as indicated?
<br /> Give detailed description ot use.including an explanation if multiple use classifications Set ,OYES ONO
<br /> VC i # £xft.o, uehtc✓ 11 a» l A . : .. •'L.,,,..le;,:.rs or ,,,,
<br /> 1.No,give percentage of exempt use:
<br /> Vz Iel2 ZJ le TOE IS4`gpor�lter• of Skepl er am 4,4, if
<br /> a10 Suffi're.F or olava
<br /> 45 t-tM as ccz.af 4o -kars.. on;w.aAS o .e-kisinsnf 40 CornSto u/ €setnk,
<br /> vE 3,Ay,il a . re of iCef Inuit vr,4, •.liar c; Cmn , Am,/ we(F,-e.
<br /> c , frt., • 54 6ret° anrt..1S C( !a
<br /> v,,k,, -hb 7 iranspriotrw'. of &a r1�' . r ens So�7(res or /emma(air
<br /> I�Nif an,Le 2.1717/ Alit
<br /> Under penalties of law,i declare drat I have examined this application and that his,to the best of knowledge and belief,true,complete,and correct.!
<br /> also declare m Shat l am duly authorized to si n this exemption axilkalion,and that organization owning the aboveasted property
<br /> does not discriminate
<br /> in membership or employment based on race,color,or national origin.
<br /> / k4.6,47_, � vw .D
<br /> sign here A ` natue
<br /> Tae Oats
<br /> FOR COUNTY TREASURER RECOMMENDATION
<br /> ENDATION
<br /> [2 - 1
<br /> PPROVAL. RECElVEaMENTf: ,!- �4/SS 11-77r.Qe::,.2.,
<br /> [DISAPPROVAL NOV 2 7 2017
<br /> Halt rn11NTV Signe re of unty Treasurer Date
<br /> TREASURERS IN LINTY 3OARD OF EQUALIZATION USE ONLY
<br /> saRAND FBLAND,N C1'.A
<br /> iPROVAL COMMENTS:
<br /> 0 DISAPPROVAL —
<br /> 4 - -0.."Z�"-_-' Z.i
<br /> 0.Au/Signature Date
<br /> Nebraska Department of Rewuue Authorized by Neb.Roe Stet 5877-202(1)(0 and(d),and 60.3.185.and 60-3.189
<br /> 36.253-2ec6 Rev.8-201:Supersedes 9E-253-2008 naa 5-2008
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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