Laserfiche WebLink
NRAst-^ 1 Application for Exemption <br /> FORM <br /> Good L,fe.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. A 57 <br /> °f°""r..,°GR"`" I •Read instructions on reverse side. I �4J/ <br /> Name of Organization. Type of Ownership <br /> CENTRAL NEBRASKA CHILD ADVOCACY CENTER 13 Nonprofit Corporation ❑other(specify): <br /> Name of Owner of Property County Name State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address 9a ntact Name . Number <br /> 2335 N WEBB RD ;sham on 4rqj el 301- 36'5 -5 a 3g <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68803 Ol reMOtz @Cmea4o rq <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State,Zip Code <br /> grArarliegiWgin"Tana. <br /> • <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 /> Vogrl FOCUS aooa Sedafn I Af'p33PQ2W198y6Y <br /> il <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ducational Religious as indicated? <br /> ❑ g ❑Charitable ❑Cemetery t�t���X_n,,rrr' <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ''C YES ❑NO <br /> U sed Pak. lvinuu-e 4 ctvta i n.i nods. -CI.OUid north l l,t( lt <br /> 1bcowl-Hu ct� -6t � loin � No,give percentage of exempt use <br /> Team meet-inc s I Ione tie Ypvf'eu) ekv\d &bur-& <br /> case-g wt-t-tA can.✓tt-y aiht'1 oPAfce, TJ NHS, °I- Lau) <br /> .akbvc.exwcx -- <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 dec..re that I am duly autho-zed to si•n is exemption apgplicalion. <br /> sign { ✓� 7a�e�lo✓ 1;f3✓Is" <br /> I�ti�". , // eGtl7 <br /> here uth.rized Signature / Title Date <br /> IFor County Treasurer Recommendation -7 �];y-� <br /> \Approval p comments: Yilvt / per NSS # 7 t-01va <br /> ❑Disapproval p ,„r,ki f L fff <br /> _pp �fi r �U/GP (kpt "i ittac lit I aJla I i8 <br /> LYE l CL' O Signature of C y Treasurer Date <br /> For Court Board of Equalization Use Only <br /> C NI-7Y <br /> TR S-I Li r Approval _. . •,_s ?' TRntS:l -- <br /> ❑Disapproval <br /> 'Autho zed S(7). um Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3.185,and 60-3.1 B9 <br /> 96-253-2006 Rev.7-2018 Supersedes 96253-2006 Rev.8-2011 <br /> Please retain a copy for your records. <br />