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Rer^—e..._. Application for Exemption FORM <br /> NNeeWeassita Department or <br /> REVENUE from Motor VehicieTaxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> APpliCcnts Name _._._.-.._ ____-___. • <br /> ___._—_.__ Type of Ownership <br /> TEHAMA SHRINE/CENTRAL NE SHRINE CLUB <br /> i RI Nonprofit <br /> Street or Other Mating Address i Cour* ' Co?poretwn <br /> West PO BOX 49 I HALL ' ❑Otitis(specify): <br /> City 44/7 t-Jest 3rd street State zip Code ----- 1 State Wham Incorporated <br /> GRAND ISLAND NE 68802 1 NE <br /> • <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide I Name,Address.City,Slate,21p Code <br /> ---P es as ------i-.ennci____L kL_ . -- 3�t�__t S-falls isr�'. _ oLL, ..-�.._is- , . AJ.E�ol <br /> Y.. ' e_ } Tquefas_ ... .I,� _Aitili pL�s?� �le1t_t'7 _a • /S .,. -.. <br /> 7rers at-e r— �— t d. Ae ian 1th7 S . gull-5 oyt sT liroM.d s • k t pate <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> i Regfahaaon Dale or <br /> Motor vehicle Make etodelYear Body Type Vehicle ID Number 1 Date of Acquisition, <br /> ..— _-_._._._._.— — _ {..-- .—... __.__.—.— ._._..--t..._._.__._—_._._....._._....__....,.—.___iitNewIfurehased_._- <br /> .I)nd9e—E4rtr__ ._._._T I afi�7 -._ 'ick-wP ---4---Lp-7FfRlmxisci/sig -----_—_--__ <br /> -s A#�t v ao1O I rrnaler I _Twit u,5kra23AA/oG9j,/SI' <br /> We.hau..l _2 000 1 7re.:l-er r3Eas 5'3Lcc <br /> {S<Xy� 9Y`NO <br /> I + <br /> I <br /> I I <br /> Exempt Uses of Motor'Vehide: _______t__ .—.___--_-- Are the motor vehicles used exclusively_-_-- <br /> 0 Agrladatmp9{oriicultural 0 Educational 0 Raigious 64 CharitaGe [_i Cemetery I as endicatedry <br /> Ohre detailed description of use,mdurang an explanation if multiple use classifications exist: 24ES ❑NO <br /> Used +o pvdl +railer WiA3o earls }o13 reef,0-G t <br /> If No give percentage of exempt use: <br /> Shrtbers Uos-p1a\& --or Children Lod to pi-mice's <br /> )7,tedt'ca..4 -ye nint.+Icr to Ike ir a, b ; 1:4 io f,a... , <br /> Under penalties of law.I declare that I have examined this application and that it It to the best of my knowledge and bens!,but complete,and,.o,,...t.I <br /> also declare that l am duly authAdxed to sign this exemption applicat ion.and that the organization owning the above-listed property does not discriminate <br /> in me hlP or employment based on race,color,or national aright <br /> sign c dl „ TPe°asuFer f/ -020/' <br /> here Authorized gnature The Data <br /> I — FOR COUNTY TREASURER RECOMMENDATION.--.—_--v_.-- —_-_-----.--.--_-J <br /> P'Cfi zPROVAL R ECE WEDCOMMEVTS: ' ,4-4.4--d 'U S'S: .7.-..a.°4% <br /> 3 DISAPPROVAL ____. . ----_---__-_-_-_ <br /> NOV 6 2017 Ad /02_a8,7 <br /> 11`igna of Treasure Date <br /> HALL COUNTY COUNTY BOARD OF EQUALIZATION USE ONLY <br /> -- - ---- -TeAStKRS orrl - -- - — --- <br /> �/ GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> ■ <br /> 0 DISAPPROVAL <br /> died Sigrte ore Date <br /> Nebraska Drpamnn I or Revenue Authoozed by we Ran Slat 99?7-292f1)tcl and(It and 80-3,MS.and 804189 <br /> 98-2512008 Rev.8-2011 Sane,eedas 98-2551.2006 Rev 52009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />