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��/ � <br /> ��-� Appiication for Exemption FORM <br /> Ne6raska Depanment of <br /> REVENUE from Motor Vehicle 7axes by Glualifying Nonprofiit Organizations 457 <br /> •To he filed with your county treasurer. <br /> •REBd I�StY1lGtlp118 Ofl 1'BVB�SE 51d0. <br /> Applicant's Name � Type of pwnership <br /> GRAND ISLAND REACT INC �Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1624 5T PAUL RD PO BOX 894 HALL �omer(specity): <br /> C��, State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,I�IRECTORS,OR PARTNERS OFTH�NONPROFIT ORGANIZATION <br /> Title Q�2 Name,Address,City,State,Zip Code <br /> �� /�vw�� zU n�5� f� G, r �� - <br /> �i �.o C'.�-y,��� e o E cµ.C�� s � � ��' o <br /> �cY>� �-���' ��r L Nl� �l. G l �'�' (��Q�3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> -Attach an additional sheet,if necessary. <br /> Reglstration Date or <br /> MotorVehicle Make ModelYear BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> C� -- �g a C4� ..o � C'SL.�2 V � L�.c <br /> � <br /> f, <br /> Exempt Uses of Motor Vehicl2: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious �haritable ❑Cemetery as indicated7 <br /> Give detailed description of use,including an axplanation if multiple use classifications exist: �ES �NO <br /> �p 41�� �'m�--,R.q�-�c-y c.��,..0�,� c�-��,� e�r� <br /> ��e �1s� �N 1�tsA��rZ R�S�P�Yv� ����� p��,�,��,� �✓c�j ' �; <br /> ° ��� � <br /> n�c � s za�t <br /> lJnder penalties of law,I declare that I have examined this application and that it is,to the best oi my knowledge and lief,true,comple orr�ct.� <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-li ed property y� <br /> in membership or employment based on race,color,or national origin. GRAND 15LAN�,NE8'qSKA <br /> sign ,� r � /z r� <br /> here Authorized Signa Title Date <br /> � FOR COUN7YTREASURER RECOMM�NpAT10N <br /> �'PROVAL COMMENTS� ���°�'aO�`", <br /> ❑DISAPPROVAL <br /> \ .t�d� --- ����-y� � <br /> �Signature of County 7reasurer Date <br /> �� FOR COUNTY BOARD OF EpUALIZATION U5�ONLY <br /> APPROVAL COMMEN75: <br /> ❑DISAPPROVAL <br /> /:�-/�- _ <br /> Authorized Signatur Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.6taL§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2D06 Rev.B-2011 Suporsedes 96-253-2006 Rev.5-2009 <br /> PL.EASE RETAIN A COPY FOR YOUR RECORDS. <br />