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����� <br /> �� Application for Exemption FORM <br /> Nabraska Depertment of <br /> REVENUE from Motor VehicleTaxes by�ualifying Nanprofit Qrganizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> HALL COUNTY LIV�STOCK IMPROVEMENT ASSOCIATION FONNER PARK �Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 700 E S70LLEY PARK RD PO BOX 490 HALL <br /> � ❑Other(specify): <br /> City State Zip Code State Where Incnrporated <br /> GRANp ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANITATION <br /> Title PRESID�NT Name,Address,City,state,zip CodeKEN GNADT�1610 GRETCHEN A�1, GRAND ISLAND, NE 6 $03 <br /> ST VICE PRESI�ENT CHUCK BOSSEL , b� ACHE ROAD, G ND I D, N� <br /> 2ND VICE PRESIDENT K�ITH JARDINE, 122 PONDEROSA DRIVE, GRA.ND ISLAND, NE 803 <br /> 3RD VICE PRESTDENT TOM DINSDALE, 1919 WEST LAMAR STREET, GR.AND ISLAND, NE 68803 <br /> SECRETARX STEVE KiTNZMAN, 2�+0$ RIVERS�DE DRIVE, GRAND ISLAND, NE 68801 <br /> RE STEV OWDI G 17 DRAK LA1VE GRAND ISLAND NE 6 1 <br /> pESCRIPTION OF TH�MOTOR VEHICLES <br /> •Attach an additional sheet,ii ne�assary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BndyType Vehicle 1�Number Date of Acquisition, <br /> if Newly Purchased <br /> SEE ATTACHED LIST EXEMPT VE ICLES <br /> Exempt Uses of Moror Vehicle: Are the motor vehicles used exclusively <br /> �Agricultural/Horticultural ❑Educational ❑Religious [�i Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: �YE5 �NO <br /> 4—H ACTIVITIES, COMMUNITY ACTIVITIES, PROMOTIONAL ACTIVITIES <br /> OF AN EDUCAT.IONAL pR CHARITABLE NATURE� HORSE R.ACING, AND o,give � �n��e� <br /> AGRICULTURAL EVENTS �NCLUDING THE HALL COUNTY FAIR, THE IV U <br /> NEBR.ASKA STATE FATR AND STATE 4—H HORSE SHOW. <br /> ��C � 6 20]1 <br /> Under penalties of law,I declare that I heve examined this application and that it is,to the best of my knowledge and beli ,true,complete,8f�tfSgr�eat.JNTY <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-liste properry doe��iio"��discriivii�afeoF�tC� <br /> in membership or emplpyment based on race,color,or national origin. ��+ti!• '=�[.AhiD.hrBF�AKSA <br /> Slgll , '�,�_�,/� � �Z�� EXECUTIVE VICE—PRESIDENT & CEO � Z� � � � <br /> l�."" <br /> ���� Autho�2?�ra Tit!e Date <br /> FOR COUNTYTR�A5URER RECOMMENDATION <br /> [�APPROVAL C�MMEN75: .Q� �J-SS ���0��`� --- <br /> ❑D15APPROVAL <br /> � ��� �a�a� i� <br /> _- <br /> Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUAI.IZATION USE ONLY <br /> �PRQVAL COMMENTS: �_�� <br /> ❑DISAPPF��VAL <br /> /�7�~ <br /> uthorized Signature Date <br /> Nebraska Aepartment of Revanue W Autnorized by Neb.Rev.S�at.§§77-202(1)(c)ena(d),and 60-3,185,and 603,789 <br /> 86-253-2006 Rav.B-2011 Supersed65 96-253-2006 Rev.5-2009 <br /> PLEASE R�TAIN A COPY FORYOUR REGpRDS. <br />