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aoc,R. <br /> N74_ Application for Exemption FORM <br /> Gooc rife.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 457 <br /> 7 <br /> oE "."E a^."- 1 •Read instructions on reverse side. aJ <br /> Name of Organization Type of Ownership <br /> YWCA ©Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property County Name State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 211 E FONNER PARK RD ::\M n 3er'rte 30 343c ( CI r(ZZ <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68801 xiti2c 1LfeC_ \y'UJL't' i lr QI((� <br /> Identify Officers,Directors,or Partners 6f the Nonprofit Organization ✓ J <br /> Title Name.Address.City,Stale,Zip Code <br /> . Ontut ' .2;b. 33 the cc+ -PAa.A C r_ALl `£ ,,C':3• <br /> AC Y-k-r, a. nitirriggirrarZa S • •- - • YYS' Z. <br /> Sr\annof1 ?cart? 1 t<-IO8 tv iA-eci '-c hL\ 195 .. C tr<YOt3 Leo <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> 1 Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> F-O aot5 -tro \S,t %%ran i C=P 'EY 2.—(A Ek. i3 <br /> yint.a 00�, e-v c M:n ks) 1 S`3IIg1! 32tk3355i2_ <br /> " -<-_)t2-0 1`tci to CGte-lo vn.r, i 'r roil I t kk9 it-i Pciostc 4 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricullural and Horticultural Society ❑Educational ❑Religious ('Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including a_n(`explanation <br /> n if multiple use classifications exist: f'-'� �'ES ❑NO <br /> rel_ ' ,' Y4 -\.,on of <ru\ren kvnjr., cs_ho7j \ �kt$'Jc^0- ¢¢ It No,give percentage of exempt use: <br /> �rti'SC�1Qi �1',Gk `.�1�0o\ QC?. ��\ 11\pS J YC'l-leNA <br /> t lcr_ -_v -- �.Aee\\ES C;K cVN,V-Vta�(-d-Srackx\ps Ile sr j • <br /> Und enalties 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 cla e that I am duly authorized sign this exemption gppl Lion. <br /> sign II, / 1I\A/r C ttte Eice_a�-{-'Iv e `\\cc.c--i v i a\tc YE) <br /> here I Author Signatur@ I, Title Date <br /> 111 For County Treasurer Recommendation j <br /> �proval RECE11f *mat P tA% nn�c <br /> ❑rrDisapproval ` ,, <br /> DEC 1 p 2018 Q \ZA 1M4 <br /> /Signature of County Tree ier Date <br /> For Cou y Board of Equalization Use Only <br /> MALL COUNTY <br /> OFFICE <br /> W I Approval GRAND!BLAND,NEBf�} 1an1 •7F❑� Disapproval <br /> ii <br /> 1 - i <br /> Ci- :` - ' t 2 ' r v/7 i 5 <br /> Authori d Signature — Date i I t <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77202(1)(c)and(d).and 60-1105,and 60-3,199 <br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2006 Rev.8-2011 <br /> Please retain a copy for your records. <br />