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2 �C:1 �01a <br /> ❑onciin <br /> NvE. -. ._. -. . Application for Exemption FORM <br /> _., a from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> ,E„„E,Ta •v.,' I •To be filed with your county treasurer. I 457 <br /> •Read Instructions on reverse side. <br /> Name of Organization Type of Ownership <br /> HEAD START CHILD AND FAMILY DEVELOPMENT PROGR ©Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property County Name <br /> State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Contact Nam <br /> 123 N HARIAN RD P one N m r <br /> Deb s Noz-�4taz 41 Si <br /> City <br /> State Zip Code Email Address <br /> HASTINGS NE 68901 GlrassOkshn.or5 <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address.City,State,Zip Code <br /> LU.Unalrt Glen ?xx,rri- arcs ldcnt-r 113 bJ. man,'" R o.cr, F{ustin2s,NF(, c1 <br /> Dcb fo Exe( u.s'.1c.IJlrecroc IL3t.t-rYILVIcalRead ,i-NGSf'In NtfPSSGor <br /> 1 1S, <br /> I <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Registration Date or <br /> i Date of Acquisition, <br /> SC.c Gd-Lrn.Ct1C-4L I Is f- <br /> it Newly Purchased <br />• <br /> Exempt Uses of Motor Vehicle' N <br /> Are the motor vehicles used exclusively <br /> [11 Agricultural and Horticultural Society E ducational El Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: gilt- <br /> 7'C° <br /> El NO <br /> rs� {a-Than or— preschaoC ch ldry -to crc�Fpm -ihc.� <br />• <br /> r(-�:� If No,give percentage of exempt use <br /> TCICi IIhi . RactiT1,3M..t 1'roja.ry.rv.c .t1.-- I.tsv 1nvJi viol CI-111442n, <br /> I]LYtn CV\LLSffc Gtct-ivilcS. <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 also eclare that I am duly authorized to sign this exemption application. <br /> sign r f <br /> here ,Authon zed Signature C1cCCaa-rk/C- Direc-nr` 10331 18 <br /> Title Date 1 <br /> For County(,Treasurer Recommendation�� <br /> Approval <br /> 1----;:7- � s :« #- Y(i11. 44 1l a Vir <br /> c 'sax d menu -kY� <br /> ❑Disapproval <br /> DEC 1 Z01B <br /> a1laSig re of County Tr u <br /> Date <br /> I r1ALL GOuraTf <br /> TO��"S:ANG. OFFIASK Count'Board of Equalization Use Only <br /> GRAND ISLAND.NEBRASKA <br /> AApproyal Comments: <br /> ❑Disapproval 1 <br /> b4J' L,)• / G!S. ra.. . � .. I <br /> •. thoriz: Signature <br /> Dat_ <br /> Nebraska Department of Revenue <br /> 96253-2006 Rev.]-2016 Supersedes 96-253-2006 Rev.8-2011 Authorized by Neb.Rev.Stat.§§77-202(11(c)and(01,and 60-3,185,and 60-3,189 <br /> Please retain a copy for your records. <br />