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NEBRASKA- Application for Exemption FORM <br /> from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> DEPARTMENT Or•EVEtUE •Read instructions on reverse side. <br /> Name of Organ ation file (� Type of Ownership <br /> � ryt, �q � v S Ae/ ,-�t,/rt ,Nonprofit Corporation El Other{specify) _ <br /> Name Ow�' f Prope y VVV'111 J "'Cp my Name State DA----',corperated <br /> a- trine I, . 1 mo moot NIe <br /> Street or Other Malt Address gpntact Name Phone Number <br /> bit 5 11 .�I' er„I L. 3eg-676- 309 a- <br /> City Greta) r5 a f�$tate Zip�qdy Erna A dress �,s'1 <br /> !11_ilT� 097 JA rs o <br /> *en ne•n A (}1 t I r �Yt'1 <br /> Identify Officers,Directors,or Partners of the Nonprofit Or Art' <br /> Title Name.Address.City,State,Zip Code <br /> ilk wL�'le7lra�ai.S_ 4 <br /> 'res�;fr�S/�—l«i. EENWAAtZ =�/1/Z►��l`Tll^h1 +�v�I�' �Lr1%f+ 'O , <br /> ll � ..,I i rrrta MilreItr 1 '.l '1 . Mfr <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 /> Y.P. ''is �� 1l A ribi irLililJ�7//ll irafi intrar� ',llg <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> Q Agricultural and Horticultural Society ['Educational lyl Religious D Charitable El Cemetery as indicated/ <br /> Giv detailed description of use.including an explanation it multiple use classifications exist: BYES ONO <br /> rze6Pecfin ttAl m cemsil -1-e 1�rt-eci (Sfele/',!cans/u <br /> 3 �C )64-; ,j/(/Q r+ a� L j „ are p lz.ce� 1 /) -Me E 03J/ It No,give percentage of exempt use <br /> (r r/a'1 Vi('�f `�j V1X I an 1 /J{V F/L I i1 l <br /> Under penalties of law.I declare that I have examined this exemption application and,to the best of my knowledge and belief.it is correct and complete. <br /> I aiggdecl a hat am duly authorized to sign this axe lion application. / <br /> Sign C 1 jJ <br /> oz- fil here Authorized Signature Title Date <br /> IFor County Treasurer Recommendation r��/ <br /> egiMprova RECEIVED Comments: 4 / e,2°A <br /> Disapproval <br /> AUG 2 2018 1 ! z_ ' ,, ,rr. - Gi <br /> ignature of County Treasur- •oat0 <br /> f HALL COUNTY <br /> TRC Fct County Board of Equalization Use Only <br /> CUnE_RS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> Approval Comments: 1 <br /> ❑ Disapproval / <br /> Author ed Signature -- Date <br /> Nebraska Department at Revenue Authorized by Net Rev.Sia1.5§77-202(11ici and(di.and 60-3.185,and 600-3.189 <br /> 96-253-2006 flee.?22018 Supersedes 96-253-2008 Rey.8-2911 <br /> Please retain a copy for your records. <br />