Laserfiche WebLink
>of - 3 7c) - 35-59 <br /> Nmake Depntot Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's nNNamee (•� �{J 7 Y Type of Ownership <br /> `�•••�` k I CS �) ` `Q. �k Nonprofit <br /> CStreet or her Mailing Address `^� <br /> •9 La�1��� \cQ, County l 1 n 1 ❑Other(specify): <br /> City `�4 A l State Zip l)ea, StaeV(hr incorporated <br /> l IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tile Name,Address,City,State,Zip Code <br /> rat.. l 'i ►.. llATMU\I , a► 11 iNfa MOCcat.1:MMIIIII <br /> r'CfIIIIIIMIIIIIffiSRITrii.st,A;aA'it3z-aretgifMrMWTMiieWMINrP...Nil- II <br /> [!w►W vA•111 •,.., 411 titAM1 i. 111 : i�t1�. ►� �.: :ttiallli <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> Co\c`R•137 rd c1DO1Z] - IlbU,S 40hth\kak?F08`iPt5 <br /> Exempt Uses of Motor Vehicle: �../ Are the motor vehicles used exclusively <br /> ❑AgriculturaLHonicuiturat ❑Educational ti Religious ❑Charitable ❑Cemetery 5 indicated? <br /> wed? <br /> Give detailed description of use,,iincluding <br /> g`lean\eexplan`atiionVIff�muaiippllee�use classifications exist: YES ONO <br /> —V\ V\s J �"\\\ `' " )\< \40 C\ � V If No,give percentage of exempt use: <br /> 0 tikcpax-\ z.\nu ccYl I AsO t ccNpc\,\,—sc <br /> t, *c\ N(2 . <br /> Under penalties of law,I declare that I have examined this application end that it is,to the best of my knowledge and belief,true,complete,and correct I <br /> also declare that I am duly authorized to sign this exemption application,end that the organization owning the above-listed properly does not discriminate <br /> I rship or employment on race,color,or national origin. <br /> sign ('AUtgrbetlsi Signature (T ���— k- -\8 <br /> here 9 Date <br /> fig�g.+..• ! FOR COUNTYTRE�ASSUURREERR RECOMMENDATION <br /> APPROVAL RLCLI Y EDMMENTs: ^"' " - 4 cil X9.7 I C7©C? <br /> ❑DISAPPROVAL <br /> JAN 292018 C X /-rarer -.ear <br /> 1 Signature of County Treasurer Dale <br /> HALL COUI'I ha rOUNTY BOARD OF EQUALIZATION USE ONLY • <br /> TRCACURERS Of'fICE <br /> GRAND ISLAND,NEBRASKA <br /> ❑APPROVAL COMMENTS: ) <br /> ❑DISAPPROVAL <br /> Am.• ' 4 Signature Date <br /> — <br /> Nebraska DeparMenl or Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60$189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />