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2011
<br /> TOBEFILEDWITM Application for Exemp#ion FORM
<br /> YOUR COUN7Y from MotorVehicleTaxes
<br /> TREASURER by Qualifying Nonprofit Organizations 457
<br /> •Read instructions on reverse side
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<br /> Applicant's NamQ County Type o(Ownership
<br /> GRAND ISLAND DTVF AND RESCUE TEAM �� �Nonprofit
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<br /> Street ar�ther Mailing Address County Number Corporation
<br /> - 31U7 WDODRIDGE..BLVD _,. -- 40 - ---- [__�otner(specity):
<br /> Ciry State Zip Code State Where hicorporated
<br /> GRAND ISLAND NE 6$801 NE
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<br /> Identify Officers,birectors,or Partners
<br /> Title Name,Address City,State Zip Code
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<br /> ��- �.�rr. _ /�,,,,� L�r��f-//z3 L-f.c%,�.�c.v��� � = o�
<br /> �s.n��" . .. �P��ws� s!o � /ST.s�2�,v -
<br /> ��R_�r�� </�r�cN �tri�, �F.��D�r_�,��cv_ �d � �.��,3
<br /> T_-'�2�/asu.eC'. __. . ��l�cx/���rf�1 :�/U 7 I,cfG�4�[Q(a.°� tvA�G���n/sL,c�sr��C�Bf?D /
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<br /> LIST SPECIFIC D�SCRIPTION OFTHE MOTOR VEHICLES
<br /> � •Attach additronal sheet if necessary
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<br /> Registration�ate or IJate
<br /> Vehicle Make ModelYear BodyType Vehicle Identitication Number pf Acquisition if Newly
<br /> I'urchased
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<br /> 1��c,.__. ��Q .-- -�_4.�4$tX� 1Jrrr�c �m�'?.83�l039 -�3�_ . _ ..
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<br /> Nature of Use o1 Motor Vehicle: Are the motnr vehicles used
<br /> A ricWturaUHorticuliural ❑ Educational ❑Religious �Charitable L]Cemetery exclusively as indicated?
<br /> C� s
<br /> Give detailed description of use,incluping an explanation it multiple classifications exist: __ �YES �No
<br /> i/�!$�/_�L�I� !�-!/4�d �.. . ---,QLlIL'rs /Q�"SG4/�_d__,[��Ul� If No,give percentsge: %
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<br /> /�_.�� .ci ._.. Ls`a.cln ��:��._r.a�N� �G,asG �ks,�c,s .-- __ ...— ---. __
<br /> Under penalties of law,I declare that I have examined this application and,to the best ot my knowledg and belief,it is correct and
<br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization o ning said propert does not
<br /> discrimi in me e i or loyment based on race,color,or national origin. W����n+���
<br /> P P TR�A�UF'-' : ']Ff•ICE
<br /> G�YA^d��SL!•,!ti'. .;'_9f;,�tfSf1
<br /> s�gn --- rcAS��e .. . .,..�/ ��� ..
<br /> here �or �dS� at� ---- T„�e -.-_ oatE
<br /> � FOR CbUNTY7REASUFiER'S RECOMMENQATION
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<br /> [�ArFRGVAL GDNifv1ENTS: ��F"� � �_��'�''�
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<br /> ❑DISAPPROVAL _.. _ _._...
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<br /> �/O �.,�S�
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<br /> ,Signature ol County Treasureri Date
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<br /> � FOR GQUNTY BOARD OF EQUALIZATION USE QNLY
<br /> [�APPNOVAL COMM�NTS:
<br /> �DISAPPI�PVAL � ----.... -- � ,' �1 � _ '�� ` ___. ,..--
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<br /> /A oYlzed Signatu � Date
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<br /> Nebreska Department of Revenua � Au[horized 6y Neb.Rev.Stat.§77-`1.02(1)(c)(d),§so-3,185§60-3,1�8�
<br /> 96-253�2oa6 Rev.5•2ao9 Supersedes 96-253-2006 Rev.t1-2008
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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