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<br /> TO B�FIL�DWITH Appiication for Exemption FORM
<br /> YOUR COLINTY from MotorVehicleTaxes
<br /> b Quaiif in Non rofit�r anixations 457
<br /> 7REASURER y Y 9 P 9
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<br /> _..., •Read instructions on reverse side
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<br /> pp icant's Name County Typo of Ownership
<br /> GRAIVa) ISLADTA A1t�.A HABYTAT FOR HiIMANITY HAT•�,
<br /> —. ..-- --. _.. _._..._. _...... .. _. _ �Nonprofit
<br /> Street or Other Mailing qddress County Number Corporation
<br /> 410 W 2ATD ST �6 PO BO% 1001 r+0 LJ Other(specify):
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<br /> Cily State Zip Code State Where Incorporated
<br /> GT�AND ISLAND N 68802 NE --- - --
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<br /> Identity Officers,�irectors,or Partners
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<br /> LIST SPECIFIC DESCFiIP710N OFTHE Mp70R VEHICI�ES
<br /> •Attach addrtional sheet if necessary
<br /> Vehicle Ma _ ---
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<br /> ke Mpdel Year R�gistratipn pate or Date
<br /> Body Type Vehicle Identifir,ation Number ot Acquisition if Newly
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<br /> Nature vf Use of Motor Vehicle: Are the motor vehicles used
<br /> �]Agricultural/HorticWtural ❑ Educational �Religious �Charitabie ❑Gemetery exolusively as indicated?
<br /> Give detailed description ot use,including an explanation if multiple classifications exist: S`�G�^r,F_C�f= C�t" �YES n NO
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<br /> Linder penalties of law,I declare that 1 have examined this application and,to the pest of my knowledge nd belief,ilYi��_qrge�a�d���
<br /> complete.I also deslare that 1 am duly autharized to sign this exemption applicatiqn,and that the organization o ing said��pe}�!�pe�qt ry��g�{qg�(,q
<br /> disCYiminate in membership pr employment based on race,Color,or national oYigin.
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<br /> here Authorizod Signature� j 7itle �ate ' `
<br /> FOR COUNTYTREASl1RER'S RECOMMENDATION
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<br /> [�„APPROVAL COMMENTS: �/��j� � F-- r�� cT�- � ._ _...
<br /> n DISAC'PROVAL
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<br /> Signature of County 7reasurer Oate
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<br /> FOR COUNTY BOARP dF EQUALIZATION USE ONLY
<br /> ❑APPROVAL COMM�N'T�S: ...
<br /> U DISAPPRpVAL * ` � ;%
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<br /> Aut orized Signature / Date
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<br /> Nebrciska Depa�tmenlof Revenue......................-- --......,..._......... ...,._ ._... . .
<br /> AuthOrlZed by Ne6.Rev.S�a�§77-2o2(1)(c)(d),§6D-3,185�§60-3,7 B9
<br /> 96-253-2006 Rev.5-2009 Supersedes 96•253�2�06 Rev.11-2008
<br /> PLEASE MAKE A COPY FpR YOUR RECQRDS
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