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dO1I <br /> N t ro; Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 47 <br /> •To be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> HOPE HARBOR <br /> 0 Nonprofit <br /> Street or Other Mailing Address 'Coun:y Corpo:aaon <br /> 615 W FIRST ST PO BOX 1544 HALL — �--r <br /> _ 0 Other(speriity): <br /> City State Zip Code Sete Where Incorporated <br /> GRAND!STAND NE 68802 1 NE _._—_.__.__.._._.. <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide I Name;Address.City,State,Zip Code <br /> --_ __ 5 . o kta eta _._--_--.__.–_._. ._._-__.–.–_— .____I__.----._._____ _._.._._..- ______ <br /> i <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 1 •Attach an additional sheet,it necessary. <br /> I Registration Date or <br /> I <br /> Motor Vehicle Make + Model Year Body Type Vehicle ID Number i Date of Acquisition, <br /> _ _ __ ___ -_,_ _�_. I it Newly Purchased------_ <br /> CaCs¢ _—_ 1�Qx:1_._.1� NhY33tObb�oiy5 <br /> p 3 I� —_ _._� i <br /> 1 -I 1 i . <br /> -'- t i <br /> Exempt Uses of Motor Vehicle: _-.__--_— I Are the motor vehicles used exdusividy -- <br /> [ Agricukural/Hortk:usurai 0 Educational [3 Reif cus haritable [-i Cemetery I as indicated? <br /> V I A� <br /> O e detailed description of use,including an explanation if magpie classifications exist: <br /> ,,,1� L I, �,�,�-� I fIl YES `;NO <br /> Gft�Wr�CS��flr s v -( rQr sp oc4- �1 WM VN t01�S [X-"CWWr I jli No,give percentage of exempt use: <br /> clettur,MJWlL for on,za_4-r Ores; -trans r-ht? Glib ri5 1 <br /> ate t erOr� COTht 5hL1-ftx <br /> Under penalties of law,I declare that I have examined this application and that it Is.to the best of my imewledge 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-lsted property does not discriminate <br /> in me hip or employment based on lace,color,or national origin. ���,��� <br /> sign t arson i A Ai ALA � �', , 1}`� 1 LU r" kt 1 VI 17 <br /> here I Tlae Date <br /> L -,_--FOR COUNTYTREASURER RECOMMENDATION `i <br /> - � AAA- s, +Tar 77 4o <br /> j PPROVAL COMM S: <br /> 0 DISAPPR04NL RECEIVED-- -- -- � d - -----'______-`---------- - ---`- <br /> NOV 2 8 2017 �cuntyTroas!//u Date <br /> FOR COU Y BOARD OF EOIUM VATION USE ONLY <br /> •• FULL COUNTY p <br /> 1,APPROVAL r,.RA TREASURERS NEBR SI !.MME S: t <br /> DISAPPROVAL • ' <br /> '_ . - / _.__ J am <br /> Path(: Signature Date <br /> Net vases:Department at Rennes Authorized by Nits rev.Stet§4 P402(1)(c)and(d).and 8:13,1$5.and 6es,189 <br /> 96-2512006 Pea 8-2011 Supersedes Ae-253.21tbf Rev S2OPe <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />