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Get Ne Dor 457 2011

On reverse side. Applicant s Name Type of Ownership Nonprofit Corporation Street or Other Mailing Address County City State Where Incorporated State Zip Code Other (specify): IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OF THE NONPROFIT ORGANIZATION Title Name, Address, City, State, Zip Code DESCRIPTION OF THE MOTOR VEHICLES Attach an additional sheet, if necessary. Model Year Motor Vehicle Make Exempt Uses of Motor Vehicle: Agricultural/Hor.

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