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2dlg <br /> illat^----e.... Application for Exemption FORM <br /> Net�asks`DepMan�mten�t of <br /> esettCNU from Motor Vehicle Taxes by Qualifying Nonprofit Organizations �.57 <br /> [ice v •To be filed with your county treasurer. <br /> •Read instructions on reverse side_-__—_-._-_--._.__._._-_-_-._.— <br /> Applicant's Name Type of Ownership <br /> ORPHAN GRAIN TRAIN RI Nonprofit <br /> Street or Other Mating Address County Corporason <br /> 427 N SHADY BEND RD PO BOX 545 HALL <br /> ____1 ❑Other(specify): <br /> City Sate Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE ! <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide 'Name Address.my,,Slate,Zip Cede - <br /> laarb t. a: A c. . - _ <br /> --�--"—�--------'------ DESCRIPTION OF THE MOTOR VEHICLES <br /> ------'-----�___..---'----_-'.,_- <br /> *Attach an additional sheet,It necessary. <br /> i I Registration Date or <br /> Motor Vehicle Make I Model Year Body Type i Vehicle ID Number Date of Acqulsrlen, <br /> __. .1- ft .lffurehased __ <br /> Icuzi <br /> f9Yf T �7aIcc.� Gc -•-L q - !I x 2esc4Jl. <br /> pc)02 _�J W ci 6 _j s .., <br /> n at/lc r 1 P-010 fow/� RA agao f _,0y .4 .� <br /> l at I( _ .L20 1 z---- --�i13 rrGZY '^ ov "sip t71/ 2a'c,i <br /> Exempt Uses of Motor Vehicle: Y Are the motor vehicles used .ely <br /> AgicuiiumItHoreadtural 0 j Education) []Religious OQ Charitable. 0 Cemetery ins indicated? <br /> �//Give detailed description of use,including an explanation if multiple use classY�catione exist: ' y YES i NO <br /> V S PR /" r rV r f!hg G k/t 1-1" . S (/r e%yCl`� of �` e/' ,11 No.\gva percentage of exempt use: <br /> p J P A <br /> r eir�� ifs. G..o/'l Collec-i-tPlli 0+ C/in �L�,i„� ci-j>ncorn <br /> do- )(Dl7S h. 6c deLrlr, bc44 C3 TjW-51c I� c lPeJ <br /> Co 4�. f- ( �Ic 9 ra e.)-1-e— )0 Fri Or37-10 <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 duty authorized to sign this exemption application,and that the organization owning the above-acted properly does not discriminate <br /> in membership or employment based on race.color,or national origin. <br /> here 7 <br /> •tiers Atli dzedsrgnaaSreA ir.��` f \cs -- a r-r r �7 <br /> I—� _ _ —_ FOR COUNTY TREASURER RECOMMENDATION _-4—_ <br /> • <br /> L434PROVAL RECEIVE®FAMENT; Az... 42SS tr77 ygaa_ <br /> 0 DISAPPROVAL -'—'----------' <br /> DEC 1 4 2017 ',e6t !S-4cf-=>7 <br /> ■signature of Treasurer - Date <br /> L __ HALL COUNTKOR COUNTY BOARD OF EQUALIZATION USE ONLY _. <br /> __._.._. _— -'I'N burtERSurmitre— <br /> GRAND ISLAND,NEBRASKA <br /> 'APPROVAL COMMENTS: <br /> ` <br /> D DISAPPROVAL <br /> I <br /> . ATMo t d Signature --- Date <br /> Neiras'•a Department or Revenue Ruewe&by Net Ray Slat$S77-202(14(c)and(d).and 60-0,1R5.and 608,759 <br /> 9G-253-200e Rey 8-2011 Suteneedes 9a-253-2006 Rev r,.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />