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94 18 <br /> ist^t--Z- Application for Exemption FORM <br /> Nebraska 1Mpa!tmen:of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations i � � <br /> •To be flied with your county treasurer. <br /> IMESEEICESSEll •Read Instructions on reverse aide. I <br /> Applicant's Name ;Type of Ownership ----- <br /> YWCA <br /> i <br /> I RI Nonprofit <br /> Street or Other Mailing Address County I Corporaton <br /> 211 E FONNER PARK RD HALL i r� <br /> LJ Other(specify): <br /> City -- State Zip Code --.State Where Incorporated <br /> GRAND ISLAND NE 68801 NE I --- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> i Tide Name,Address.Cdy,State,Zip Code <br />.., .Px111te.ib�'iye,�e�(����''�1-"c�a�,,, _j - -glSt' __ _IT_ —_U_-- ,�2e_dr-st—e .t_Ltt&Qf_Bg?._______-___. <br /> DESCRIPTION OF THE MOTOR VEHICLES ._-_----- _ _--_.__.__-_._._---_-_ <br /> *Attach an additional sheet,If necessary. <br /> Motor Vehicle Make Model Year Dody Type i I Registration oDat n, <br /> Vehicle ID Number I Date Acquisition,to <br /> I __ I I It Newipurehesed _ <br /> �• i OD ___._._..t_. -JfW 4! -t i Loa a 4.r�-_l - .. <br /> i I <br /> __ -- <br /> _ L <br /> Exempt Uses of Motor Vehicle: - --_ Are the motor vehicles used exclusively <br /> 0 AgrkulturatMonianaursl Liz Educationar ❑Religious pChadtaUe 0 Cemetery. as Indicated? <br /> e <br /> Give derleted description of use,Including an explanation it maniple use lass' .ions exist: � '" � �,,pp 1 YES )^j NC <br /> 1, 'IYnS v nn oc Q,k W 'Dy1 d )\M 0U� 46 Y0Q9"i <br /> `,li No,give Percentage of exempt use: <br /> 02. gib,- ' a. 9_D'L6s� ,Peed -i- s rats- 1 <br /> ck bees ✓,�'iir Cie;e-r ' <br /> 3 � <br /> P � <br /> i <br /> Under penalties of law,I declare that I have examined this application and the it is to the best of my knowledge and belief,true:complete,and correct.I <br /> also declare that am duly authorized to sign this exemption application,and that the organization owning the above-hated property does not diwwtrrnate <br /> in membership or employment based on rape,Sor,or national origin. �v <br /> sign 6.. 1I_:su►.. . .. ee , MrMv__ ___ <br /> here Anh .ii? - fe 3c1c, ,tr, ',Gi.aa. The Date <br /> L _ Maµ,y"ISC; A FOR COUNTY TREASURER RECOMMENDATION i <br /> PPROVAL RECEIVED COMMENTS: .G�~ / y X� 7riaD <br /> 0 DISAPPROV _--' ---------- ----------------------- <br /> - - - /�4G.-/7 <br /> NOV 1 4 2017 Signet auntytrreasurer Date <br /> I_—_ _ �—�___— FOR COON_ BOARD OF EQUALIZATION USE ONLY i <br /> TREASURERS COUNTY <br /> URERS O I <br /> t APPROVAL GRAND ISLAND NEBRAKAAME S: <br /> 0 DISAPPROVAL <br /> Signature _— .—_._._._ Date <br /> Nebraska Oepwlne't m Revenue Arawrhed by Neb.Ray.Stel.to?7-?02n)(c)and(I.and 6&S.185.and 604.189 <br /> 96-253-2006 Rev.8-2011 awaasedes e6-253.2006 Rev SY0o9 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />