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isern----Z-- Application for Exemption FORM <br /> Nebraska Deaanment of <br /> REVENUE 1E from Motor Vehicle Taxes by Qualifying Nonprofit Organizations �57 <br /> *To be filed uctn your county treasurer. <br /> •Read Instructions on reverse aide_.__-_____._--_.__.__ <br /> -Applicants Name Type of Ownership <br /> YMCA tic;Nonprofit <br /> Street or Other Mailing Address 1 County Corpora on <br /> 221 E SOUTH FRONT ST i 1 HALL <br /> — -- one,tsi v): <br /> -City -- State zip Code — State Where incorporated � <br /> GRAND ISLAND NE 68801 1 NE --_-_._._-_-....__ <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide I Name Address.Cfy.State,7m Code <br /> fltri!11-�tl offniiIL�! llatifr--7 PF Ale -.; ; _ <br /> / <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet it necessary. <br /> I I i 1 Registration Date or <br /> Motor Vehicle Make i Model Year Body Type Vehicle ID Number i Date of Acquisition, <br /> —_._. ._- — _ t _. ___ NayAy Purchased._..._Lea I <br /> f, . i Gl � r ? 553 , a — <br /> t Litrirl� � J •S' itajllt/SIr rls- e ; <br /> t i <br /> Exempt Uses of MotorVehicle:- —_— -_ _-_-_--__ — i Are the motor vehicles used exdusivpy <br /> fl Agriculturattiorticultural [j Educational ❑Religious 1.‘Charitable 0 Cemetery i as k dice ed <br /> ON/e detailed 1description of use,Including an explanation ifJrmxtiple use classifications exist 1 it ES L NO <br /> 41 if 2/1iG{/es 14;ht,c4`L�) `4, �`// ,2or� Oce rill /� I If give percentage of exempt use: <br /> r f 7D J`Ctf/K kda 5 ®;N4T nil,j Q >t <br /> mtssre� �'�� * <br /> fot- 4I1. <br /> Under penalties of taw.I declare that I have examined this application and that ft is.to the best of my knowledge and belief,bus complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application.and that the organization awning the above-listed property does not discriminate <br /> in membership or employment based on race.color,or natloael origin. <br /> sign n & coo 1z/4128x7 <br /> Jere Mtoo bra Tine Date <br /> t__—._.�.------_—___. -_ FOR COUNTYTRREA/�SURREERR++RECOMMENDATION —_�_ _ _—_—I <br /> APPROVfi_ " COM "NT"S: `-- ' / 4/557 -"7'l�O.2 <br /> RECEIVED <br /> 0 DISAPPROVAL <br /> DEC 6 2017 £? t WQ�'' A- l�'-"'d-y7 <br /> It Signature of Co my Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY ._._._.__—. ._.__ <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASK€1014.ENTS: <br /> E?APPROVA-L <br /> DISAPPROVAL �. <br /> Or►•-!! ._ — — _1=�- <br /> signature Date <br /> Neb•asxa Oapanmaal of Revenue Authorized by Neb.Rev.Stat.§§7f-2e211?fc:and(di.and Bo-San and e0-3.18e <br /> 96-25.1r2006 Pew 8-2011 Swerseuss fro-M-2006 Rev:0-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />