Laserfiche WebLink
2011 <br /> 70BEFILEDWITH App�ication for Exemption FORM <br /> YOUR CdUNTY from MotorVehicleTaxes <br /> 7REASUREFi by Qualifying Nonprofit Organizations 457 <br /> •Rend instructions on reverse side <br /> -.. ._ _ . ._ _.... _...._. __ <br /> ---. <br /> ApplicanYs Name County 7ype of Qwnership <br /> AMFRICAN NATIO�dAL RED CROSS HAI I, �Nonprofit <br /> ----------- --., _. ...._ _... . ....-- ----... .- -- . . __ - - <br /> Street or Other Mailing Address County Number Corporation <br /> 404 E 3RD ST 40 <br /> --- - --- ❑Other(specify): <br /> ----- ---------.__.. .--- <br /> City State Zip Code State where Incorporated <br /> cxarm �st�n rrE �sso1 NE <br /> --- -- _ .. <br /> Idenlify O(ficers,Direcrors,or Partners <br /> - ---- -. .. . . -- ---... ------.._... . . . .. ... ... --- ------ <br /> Title Name,Address Cdy State,Zip Code <br /> rJ@G' .A�..... _. ----..__. <br /> --- ------ ---.. _ <br /> tached List <br /> - -.. -- ---- -----._ <br /> LIST SPECIFIC DESCRIPTIQN OF 7H�MpTOR VEHICLES <br /> �Attach addikional sheet if necessary <br /> - - --- _. ----- —--.. <br /> Reyistration Date or Date <br /> VphICIP h^�7ICP Mndel Year 8ody Type VL'Y1iCIF.�CIEYI�i(iCd{iOl�NUfT1hCf of Acquisition if Newly <br /> I purchased <br /> --- <br /> __ -- - ----- — <br /> Ford_ .__ 2009_ -- Ambula_n.ce . . 1 .F.DX�45f].9.DA80312.. _._.- ------- <br /> --- - <br /> Chevy 2001 Venture ____.__ 1GNDX03F61D�Q77�� .... _.. <br /> -- ---- — - _....._.__..... <br /> _ -- <br /> Buick _ 2005 ----- _L_eSabre _�21C2�1�7.�38u. <br /> Forc! --- 1981 ... V�.nL.Amlaula_n�e_. ]FTJ53.4.L6B.HA50.1_66 -- ----._ -- <br /> _.. ..�.. _--- _...._..-- <br /> Nature of IJse of Motor Vehicle: Are the motor vehicles used <br /> �Agricultural/Horticultural ��Educational ❑Religious [�.Charitable ❑Cemetery exclusively as indicated? <br /> Give detailQd description nf use,including an explanation if multiple classifications oxist: Tk1� American R�d _ �r�s �NO <br /> Crass uses the vehicles ta responci to fires and other disasters. <br /> --- �---iFNo:'9ive percentage �,�- —""%'"- <br /> The van is ._a.lso used for trav�l to Health and 5afety classes. an � _�_ ";.�� `�'°�� �' <br /> c�eneral transportation related to the Ch_apter.,..__a.s is__the......LaSa.br <br /> _..,.. ) <br /> ,, n <br /> _ <br /> _,, , <br /> . . ..�_ � v <br /> ._ ._ _..._..._..- --- .... . . . . _......... <br /> Under penalties of law,I declare that I have examined this application and,tn the best of my knowled e and belief,it is cor ect a d <br /> compleke.I also declare that I am duly authorized to sfgn this exemption applicatian,and thac the organizatian wning said�qp��{�i���F���,� <br /> discriminate in membership or employment based on rece,color,or national origin. ��qN�j���p,p,}� NiE�F�.ASKR �� <br /> .g -� _ , <br /> SI Il �-�,��,�����- '�;�ti�,a,�� Executive Director 11--29-1p <br /> _ _ .. .......... ...--- ---. <br /> h ere - ---..___..--- <br /> AutFiorized Signature ` Title Date <br /> -- ----- -.... .._ <br /> _ <br /> � FOR COUNTY7REASURER S RECOMMENDATION <br /> �PPROVAL CQMMEN7S' �1 ���-S J�� '�'`��'�`'� <br /> �DISAPPROVAL <br /> . _.. _. <br /> �: ^ �� <br /> ► � �.� `�'�;�,��n� /l �, <br /> � � .� <br /> --.. .. . ----- <br /> Signature of County Treasurer Date <br /> - --------... . . <br /> ------- <br /> � �QR COUNTY BOARD OF EQLIALIZNTIpN USE ONLY <br /> ❑APPRaVAL GOMMENTS: <br /> U DISAPPROVAI. � t._ .__...._ � � ,fl ; ` <br /> ---._.._. -- <br /> � �. �'� . � \^`.. " � <br /> ... _ ... -------- <br /> I Authorided ignature � � / Date <br /> _._ _.... _. ...--- — --------.. ...- -- <br /> Ne6ra5ka�epartment of R9venue Authorized by Ncb.Rev.Stac§77-202(1)(C)(tl),§60-3,185§60-3,1 B<J <br /> �J6-�253-2006 Rev.5-20D�J Suporsedes 96-253-2006 Rev�11-2008 <br /> PLEA5E MAKE A COPY FOR YOUR RECORDS <br />