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Ale with Your Application for Exemption FORM County Treasurer from Motor Vehicle Taxes by Qualifying Organizations 457 •Read instructions on reverse side. Name of Organization i Tax Year Value of Motor Vehicles -t- e SCI-Wa.-�-w el �w`.�.{ -O L(o ,i, )c)c) . v 0 Name f Property Th� r os ct v ciAturt Ar County 1 State where incorporated Street or Other Mailing Address Name Phone Number Si S '0 3 'B 5+ M r t s�-i-r, 3a-a e-a-4d- . City State Zip Code Email Address C.r-a n-d S-St_a.il.cl the Cce386i ris{crle. a I -t f (CSC-sa[uu-4-to r 644,09 Type of Ownership: ❑Agricultural and Horticultural Society 0 Educational ( Religious Charitable ❑ Cemetery ❑ For-profit Nursing Facilities Charitable Organizations:Motor Vehicle described above Is used in the following exempt category(please mark the applicable boxes): 0 Agricultural and Horticultural Society Educational R Religious 5Z Charitable ❑ Cemetery Charitable and For-Profit Organizations,please answer the following: if No,give percentage of exempt use: Are the motor vehicles used exclusively as indicated?(see instructions) igiYES ❑ NO q• For-profit Nursing/Assisting Uving Facilities,please select the applicable box. What percentage of occupied beds have been provided to ❑ Nursing Facility ❑Ski§ed Nursing Facility ❑Assisted-Living Facility medicaid beneficiaries over the most recent three-year period? oA Name Title of Officers, Address,City,State,Zip Code Directors,or Partners min`,d I Assn G Land..) mid 5 Sa Prcu re &lome_ file ko.y E-iot-rina't es i-L• S 12i1 ward d \l:`cc Dreg►`ctr ,t Description of the Motor Vehicles .Attach an additional sheet,if necessary. rilsa Motor Vehicle Make Model Year BodyType Vehicle ID Number Oae oft Acquionr if Newly Purchased Tc -0./ �01-5 . -1-3SO _1 '13 Ca9-M1 Vk4 d lit a1 a4 Give a detailed description of the use of the motor vehicle: cG.r1 9 1 +tst)o p:t...•--'--ps G3rec4, B n "Lill 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. I also declare that I am duly authorized to sign this exemption application. ;�,, �r�j Sign e D cc-e 14 `f r-abLiP b'L / oZC,o here 'Authorized Signature Tide RECEIVED • •unty Treasurer Recommendation 1�f;•proval Comm:nts: EXEMPT PER NSS#77 202 ■ Denial MAY 2 8 2026 - ! ' bd� �6ASUOFF s� �1C,► ounty: easurere1 DabsTREARERR �ae APOPL)ISLAND,NESRASgt , , my Board of Equalization Use Only Approved If the County Board's determination is different from the County Treasurer's recommendation,an explanation is required. ❑ Denied I declare that to the b my knowledge and belief,the determination made by the County Board of Equ ' ' n is correct pu ant to laws of the State of Nebraska. Sfgrt of Colin and Member Rev.7-2024 Authorized by Neb.Rev.Stat§§77-202(1)(c)and(d),and 603,185.and 60-3.189 Please retain a copy for your records.