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men---x -7 Application for Exemption FORM <br /> Nebraska Departmentoq <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457•TO be filed with your county treasurer. I <br /> PROPERTY ASSESSriENT •Read instructions on reverse side. <br /> Applicant's Name I Type of Ownership <br /> CENTER FOR INDEPENDENT LIVING 7�/Nxiprorit <br /> Street or Other Mailing Address County / 'Corporation <br /> 3335 W CAPITAL AVE HALL C (seer**State Zip Code State Where Incorporated I <br /> GRAND ISLAND NE 68803 NE i <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title -( Name.Address,City,Stale,Zip Code <br /> _ <br /> 1 eGiTci d---Cy\I— —fi m Yolh,c90aCThile-toff IFrototan 1NE L,%939 — —• re ' • r V_ 3df Koji);31ci tl. rlliricl fn �1 LOCI•en, NC L 95`) - _ , <br /> Y r) Mann 0- r rniieh CDreer.wal\ yob � rctv2c�?coo ms?rr�m u , N b$(oloSo <br /> n9 ff 4lnb-er 4 repo ► c s __ in; I. iQ rti /'eve ,Frw mon 1- },LVC 6 Su>;36 <br /> TJ ineneibtr' ci-w MNllt.r, ,ICS CCFh>^wOr,cif I NOr' PIYIJQ ,the G9leI <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition. <br /> If Newly Purchased <br /> Chew 7rnparc,-- eq606— __! '-r S-et. n t or ' . 9 . 3,9can, <br /> F7ivcl lb uro tt Soo") Cl b pr e •l IF4-F '53LAX-1A 16 9160 _ <br /> Exempt Uses of Motor Vehicle: -- --- Are the mctor vehicles used exclusive& <br /> ,0 AgricuNuraWWiorh'cultura) &Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: rNIES ❑NO <br /> 'Olt OV dig nCI` \I 1 j Svp )r`t Serif crs <br /> t It If No,give percentage of exempt use: <br /> \-3y�V� cat_ �Y, .1eY.1 C aUCCA-ti0) --kw Pa°P'� WIljh dl�lb es <br /> "i-Y--emsz. 'r, J-- 0-t- 3/x3 -gazes . <br /> Under penalties of law,I declare that i have examined this application and that it Is,to the best at my knowledge and belief,true,complete,and correct.I <br /> also decla a that 1 am duly authotized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> In membership or employment based on race,color,or national origin. <br /> sign <br /> here S, air® — - -- title c.c YN..le _ Date .--I 1 <br /> FOR COUNTY TREASSUREERR RECOMMENDATION '/ oat <br /> PHOVAL COMMENTS: "� '� ° /CC 445:5 *77 Q <br /> []DISAPPROVAL RECEIVED <br /> Y■ ^�'�y9fr /,_4 9-/7 <br /> NOV 1 4 20 S"�-gatule dl Chi my Treasurer Date <br /> R COUNT"BOARD OF EQUALIZATION USE ONLY <br /> ( f APPROVAL TREASURERS OFF€EWMMEM <br /> GRAND ISLAND,NEBRASKA <br /> ❑DISAPPROVAL <br /> Iliv` / <br /> — <br /> /- 5 /cV <br /> Fad Signalise. <br /> z <br /> Date <br /> Nebraska Depuronest of Revenue Authorized by Neb.Nev.Stat.g§T7302t1)(c)and(d),and 60-3,185,and 60-3.189 <br /> sues-zoo6 Rev.6401 I Supersedes 96-263-2006 Rasa 6-2006 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />