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v " 1 i <br /> Application for Exemption FORM <br /> Goon u te.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 4 L 7 <br /> r."—M1°^'°E"°• •Read instructions on reverse side. I —eJ <br /> Name of Organization Type of Ownership <br /> }4!EBRASKA DISTRICT COUNCIL OC THE ASSEMBLIEWS C ®Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Properly County Name State Where Incorporated <br /> i HALL NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 1503 W 2ND ST PO BOX 1965 Curti S'C/i&tF (3aP)3i4t-/a2311 <br /> City State Zip Code Email Addre <br /> GRAND ISLAND NE 68802 aim neal•or4 <br /> Identify Officers,Directors,or Partners of the Nonprofit O anization 1 <br /> Title Nge^e,Address,City,State,Zip Code <br /> Eta/daft Aktrt W'aw COG 6 saw Strut Pl . Kuzi a� ( 47 <br /> u�eridal/rrnzumety Tura ar wsz 3z irtid aitwn Lasu ( LQ dig &ill <br /> Thiraf zrr Terra iiayt slog T rtberrielv, hr , 4/him, Alt Sad33 <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 /> it Newly Purchased <br /> o c/a. enna ,e2014 13/h t PsS'GQ. 5-7b/tabA?EsSae'/30o2 1-So-I1 <br /> C ,,, IL 1%oo .1. j .[ 7: t 16,, "7 £' a (1 1-3098 <br /> rhl`T JJWWWOSAFS llq‘ Fnc as.? ' r'Lg2 '1. ,s-iob1c73.oao ,`S 1 - tH. <br /> " °i Al Trailer 7t lc .2 105/46 abo5 Urildy 172.1-C '1Te7c$/9 2158065201 /- 11-17 <br /> - <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> Li Agricultural and Horticultural Society ❑Educational Religious ❑Charitable El Cemetery as indicated? <br />• <br /> Give detailed description of use,including an explanation it multiple use classifications exist: 211YES ❑NO <br />• <br /> Tlat veld des are toad iv flue, ,Datc%ral uzre la dur 6V51 t uuwakes <br /> ���� If No,give percentage of exempt use <br /> awl of mutt p15 Rinislrts attars A shtle of 111 Musa. They % <br /> are tad Iv etereiinak WAY i Arienitoi bark, a a, empeps, <br /> CarwE+ r, Sian-,_ eke. . <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 declare that I am dui ed to sign this exemption application. <br /> sign <br /> �Ii �-.9 �s 1,.� �2 r3 _,�. <br /> here Authori2 ignatu _� Tite Date <br /> IFor County Treasurer Recommendation <br /> -7 n 1 <br /> tApproval f I 4.P�ammenG: U7-i/ t �XA MSS #1 l-Dioa <br /> ❑Disapproval 90 Yy <br /> a <br /> DEC 1 3 2018 � t�... i L.L fit f. 1.,._L lcI1310 <br /> tgnature of III ty Treasurer Dale <br /> 11.4LLCOUN7`� For County Board of Equalization Use Only <br /> TREASURERS OFFICE <br /> GRAND ISLAND NEBRASKA <br /> [Approval "--"Comments: <br /> ❑Disapproval , <br /> • <br />• <br /> �. . A 7 <br /> Author zed gnat e , D.e <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(0 and(d),and 60-3,185,and 60-1189 <br /> 96253-2006 Rev-92018 Sopersedes 96-253-2006 Rev.8-2011 <br /> Please retain a copy for your records. <br />