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��� <br /> ��- Application for Exemption FORM <br /> Nobraske Depertment of <br /> REVENUE from Motor VehicleTaxes by Dualifying Nonprofit Organizations ��� <br /> •To be filed with yqur county treasurer. <br /> •Read instructions on revcrse side. <br /> ApplicanYs Name Type of Ownership <br /> GRAND ISLAND DIVE AND RESCUE TEAM �Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3107 WOODRIpGE BLVD HALL <br /> �pther(specify): <br /> Gity State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,�IRECTORS,OR PARTNERS OFTHE NONPRpFIT ORGANIZATIqN <br /> Title Name,Address,City,State,Zip Code <br /> P E O �� � � C7 <br /> !/� f� D �� E � <br /> J ! � ..� <br /> DESCRIP710N OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> negisirdtinn Date or <br /> Motor Vehicle Make Model Year 8ody Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> L/ �G C' <br /> zoo <br /> Exempt Uses of Motor Vehicle: � Are the motor vehicles used exclusively <br /> �Agricultural/Horticultural �Educational ❑Religious IAI Charitable ❑Cemetery as indicated? <br /> �W� <br /> Give detailed description ol use,including an explanation if multiple use classifications exist: �YES �NO <br /> �/5 Ti�rS7l[.C�' !3 �EO.....rO. 1�a9.r✓S.��e� ��I/E .��C'SCcl4� EQf.///��itfT. . <br /> . <br /> Fi�A/S/! .�[i�AG .G'i.eE ST��7�/ !.V C��'f+��vs' <SLA•v� �E.7't�A�/Y v�d4 n <br /> �c�4T�D ACc�.4E�!T`._�s'��� i•v.�.v,o .4�ou.c� �.,'A.u�� �St�D._.(r_� � EI �V <br /> M.�'/ �450 �E uSEaD �A�- ..tr✓�vL�.� �A�e?FP?' P7eA��csla G'Gs9S$dTT.�s <br /> �,�r �.e,�.�o _�s��,v�___,v� R�..,o .or�r�e -��s� _ra,.w,�s._ . __ NOV 1 5 2�11 <br /> Under penalties of law,I declare that I have examined this application and that it is,ttl the best of my knowledge and bel f,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-liste property do i���TY <br /> in members ip or employme ased race,color,or national origin. RERS AFFIG� <br /> GRAND ISLAND.NEBitASKA <br /> sign !/- /5-// /.e�-,� ,�9a��4�1 <br /> here Authorize Sig Title Date <br /> FOR COUN7Y TREASURER RECOMMENpATIpN <br /> �PPROVAL CdMMEN7S: �Q/.�- /I�-S-� ����°�`� <br /> �]DISAPPROVAL � <br /> . ��� --- �a/ay/`/ <br /> Signature oF County Treasurer Dafe <br /> FOR COUN7Y BOARD OF EQUALIZATION U5E QN4Y <br /> �APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> l:--��'��--- <br /> Authorized Signature Date <br /> Nebraska Departmenl of Revenua AuthOrizOtl by NBb.%ev,513t.§§77-202(1)(C)Bnd(d),Bnd 60•3,185,and 60-3.189 <br /> 96-253-20�6 Rev.8-2011 Supersedes 96-253•2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR R�CQRDS. <br />