Laserfiche WebLink
C 3(C\ <br /> NEB C1K^ Application for Exemption �°J��3 <br /> Good�.fe.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations FORM <br /> .••••-•—•••••-• •To be filed with your county treasurer. <br /> I J 457 <br /> •Read Instructions on reverse side. <br /> Name of Organization Type of Ownership t <br /> SENIOR CITIZENS INDUSTRIES INC 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 Name <br /> 304 E THIRD ST Phone Number /�� <br /> City State Zip Code Email Address aLZ <br /> �` 6k1/4 to w�� <br /> GRAND ISLAND NE 68801 �� <br /> Identify Officers,Directors,or Partners of the Nonprofit Organi��� ;`\ 'h 5'��' <br /> I Title` Name,Address,City,State,Zip Code <br /> I, tct..inliACAtokTh <br /> I <br /> I <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make Model Year I Registration Date or <br /> Body Type Vehicle ID Number Date of Acquisition, <br /> t " [.� it Newly Purchased <br /> 1 <br /> Exempt Uses of Motor Vehicle: <br /> ,,,,(/ Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society 0Educational 0 Religious 1L Charitable 0 Cemetery as indicated? <br /> ''Giivetd�etailed description of use,including an explanation if multiple use classifications exist: IIIIII"``������"'''' 74YES fil NO <br /> EliiCIt pub 1 i L fr(,d\3e:::.d'Vo-4'iOVi If No,give percentage of exempt use <br /> 2,r resiiU?Mee `tt-N. 4-Lit Coumti f <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�a�that I em duly authorized to sign this exemption application. <br /> sign Il'nlyJ..V�r..tgi�Ol�/, \ <br /> here IAuthorized Signa t - �nSa-t OccC C' 16P� = _ � <br /> Tide Date <br /> i_ For County Treasurer Recommendation i <br /> -,Approval Comments: (iY � NHS# 1--aoa <br /> v❑Disapproval RtCtIV D 777 <br /> . ,.C' �j �a� 1T -pe ir>tasu ' ia/ia/�8 <br /> DEC(-:, �; „^.` Signature of ty Treasurer Date <br /> For Coun, Board of Equalization Use Only <br /> 1 <br /> ALL ft pproval TREASURERS OTMf Iments <br /> GRAND ISLAND NEBRASKA / \ <br /> Disapproval <br /> J <br /> f ------ <br /> Author ed Siiggna ucee Date <br /> Nebraska Depadmenl of Revenue <br /> 96-253-2005 Rev.7-2018 Supersedes 96-253-2006 Rey 8-2011 AuthOriZad by Neb.Rev.slat.§§]]-202(1)(c)and(d),aM 60-3,18s,and 60-3,183 <br /> Please retain a copy for your records. <br />