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�d� . <br /> � f�r���-`� <br /> .,���� Appiication for Exemption �� ,1-a �o�nn <br /> Nebraska Department of <br /> �p��c�� rC from Motor Vehicl�7axes by Glualifying Nonprofit Drganizations 457 <br /> G�I G UG •To be filed with your county treasurer, <br /> •Read instructions on reverse side. <br /> Type af Qwnership <br /> ApplicanFs Name <br /> American National Red Cross �J Nonprofit <br /> Street or Oth�r Mailing Address County Corporation <br /> 404 E. Third St �a�� <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> Grand Island NE 68801 N� <br /> IDENTIFY OFFICERS,DIREC70RS,OR PARTN�RS OFTHE NONPROFIT ORGANIZATI�N <br /> Title Name,Address,City,State,Zip Code <br /> See Attached List <br /> DESCRIPTION OFTHE M070RVEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year 8ody Type Vehicle ID Num6er Oate of Acquisition, <br /> i�Newiy Purchased <br /> Dodge 2006 Durango 1 D8H858276F102113 11/1/2011 <br /> Are the mvtor vEhicles used exclusively <br /> Exempt Uses of Motor Vehicle: as indicated? <br /> []Agricultural/Horticultural ❑Educational ❑Religious QC Charitable ❑Cemetery <br /> Give detailed description of use,including an explanation if multiple use classifications exist: �YES �NO <br /> The American Red Cross uses the vehicle to respond to fires and oth�r disasters. It is also If No,give percentage of ex�mpt use: <br /> used for travel to Health and Safety classes and general transportation related to the � � �.��_,�.,, �� :. <br /> � ---'�'.-=�^: � F'!'s ry�;�f a�� <br /> Chapter, as is the LaSabre. ; L`;.;�,��i�,.r�i�� <br /> P�o�r � a �a�l <br /> Llnder penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and b ief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-list d property does r�at discrirrri��te;y <br /> mambership or employment based on race,color.or national origin. TRF�Ac.�.;!�I_'���e�'FtC� <br /> (`v.nNr)1��[..l�r.�tJ.NESR'r�,'� ..=:.+� <br /> $j p ; � �,--� Executive Director 19/14/2011 � <br /> h�e Authorized Sig ature Title Date <br /> FpR COUNTYTR�ASUR�R RECOMMENDATION � <br /> �APPROVAI� <br /> C�MMENTS: �a� <br /> �DISAPPROVAI. <br /> � ;i� ��— /� _// <br /> �Signature of County TreasGrer f7ate <br /> F�R COUNTY BDARD OF EQl1ALIZATION USE ONLY <br /> �APPROVAL COMMENTS: <br /> []DISAPPROVAL <br /> Authorized Signature � "°'��C��� <br /> Ne4raska Oepartment of Hevenue Authorized by Neb.Rev.Stat.§§77-2o2(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-200E Aev.B-2011 5uper5edes 96-253-2006 Rev,6-2009 <br /> PI��ASE RETAIN A COPY FORYOUR RECOROS. <br />