Laserfiche WebLink
green---z— Application for Exemption FORM <br /> Nebraska Dopartmem or <br /> Ail from Motor Vehicle by Qualifying Nonprofit Organizations 457 <br /> •, '�` k �� •To be tiled with your county treasurer. <br /> PPOPCal+assESWENT •Read instructions on reverse side. <br /> --_ -- _-_-_ -_--- --_-----_- <br /> :CanYS Name y�/� Type e of Ownership <br /> MOSIAC f `0$A-i c RI Nonprofit <br /> Street or Other -i pig Address I County Corporation <br /> 2846 • I FAIR RD I HALL <br /> City ---- _ --- Spite --- Zip Code 'State Where Incorporated I U Other Ispecifyj: <br /> GRAND ISLAND NE 68803 NE i ..............—._..._. <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name Address.Ciy,State,21p Cods <br /> DESCRIPTION OF THE MOTOR VEHICLES -----_- --------------- <br /> •Attach an additional sheet,R necessary, <br /> I ! I Registration Date or <br /> Motor Vehicle Make '--Model Year Body Type <br /> e' -yy i Vehicle ID Number 1 Date at Acquisition, <br /> -ILA _��i d-C . - 3 —k-YL(c.Ck 1)44 I,t 1t$' , a 1NOwix_u �_.__ <br /> Ca - Y 11.“:.1. a _ le- "c-,—s�J <br /> I <br /> Exempt Uses of Roo:Vehicle: �.,{ Are the motor vehicles used exclustvety <br /> 0 Agrkukurelliorticwtural ❑Educatin& i7V Regous ❑Chnantabe 0 Cemetery as indicated? <br /> Dive detailed description of use,including an explanation if mtstiple use classifications exist NrYES ENO <br /> 1—,ray,/a 11---04-00,1 0 4 i a-4 Ce x I it No,gve percentage of exempt use: <br /> ,l tteVeliiJic`t o4 J'• /dam % <br /> i <br /> Under penalties of law,l declare that I have examined this application and that it is,to Its best of my knowledge and belief,true.complete,and correct.I <br /> alsodedare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> In mamba ip or employment an race,color,Or national Origin. <br /> Sign e Alt-"-r; AS3 t. 1/— 7-7/ 7 <br /> here (° thorized ' nature Tide Date <br /> I.-,-�—�---�--'-- .-- FOR COUNrYTREAFSUURREER RE�COOMMMME E NDA TION-----------------------�—'---1 <br /> V APPROVAL COMMENTS:---yz—"- / - 4,/,...5:5 X 7747 o <br /> 0 DISAPPROVAL RECEIVE_--__-_--._-._._—._._._._-_-__-_--._--.__—_._— - _ . <br /> /''-4c /7 <br /> NOV 1 h 2017 ®Veneto feoTCOSnly Treasurer Date <br /> i FOR COUNTYOARD OF EQUALIZATION USE ONLY _ J <br /> �r+PPROVAL HALL COUNTY MENTS: <br /> TREASURERS OFF , <br /> GRAND ISLAND,NEBRASKA <br /> 0 DISAPPROVAL <br /> 01 is- <br /> -_— 1 -��"- <br /> rized Sfgrwt1 --- ----- Data <br /> Nebraska O[yarenard of Revenue Authorized by Nab.Rea Stan,$§77-25320 go)and().and&.V,,a5.and 80X3,189 <br /> 96.25$-Gee Rea s2.01 I Sunersedee 90-20-2006 Rev 5.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />