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�l.-�l�, <br /> �r►-�- Applica#ion for Exemption FORM <br /> Nepraska bepartment of <br /> REVENUE fram Motor Vehicle Taxes by Qualifying Nonprofit Organizations 45,7, <br /> •To 6e filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> ApplicanYs Name Type of Ownership <br /> UVEI�LAND TRAILS COUNCIL BOY SCOU75 OF AMERICA �Nonprotit <br /> Street or Other Mailing Address County Corporation <br /> 2808 O'FLANNAGAN STREET HALL <br /> ❑Other(speclFy): <br /> Ciry State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE 501(c)(3) <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> EXEGU7IVE BOARD PRESIDENT RON VONDEROHE,4218 MICHIGAN 5T,GRAND ISLAND,NE 68803 <br /> EXECUTIVE BOARD TREASURER TYSDN CDBLE,1323 N.MINN�S07A AVE,HASTINGS,NE 68901 <br /> EXEC BOARD SEC&SCbUT EXEC. DAVID PLbND,1519 W.DIVISION ST,GRAND ISLAND, NE 68801 <br /> COUNCIL COMMISSION�R GLEN JORGEN50N,315 W.9TH STR�ET,HASTINGS,NE 68901 <br /> DESCRIPTION OF THE MOTOR VEHICL�S <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> MotorVehicle Make ModelYear BodyT;pe Vehicle IQ Num6er �ate of Acquisition, <br /> if Newly Purchased <br /> GMC 1996 CARGO VAN 1GTFG25RXT1033D5 3-12-2007 <br /> DODG� 2008 MINi-VAN 1�8HN44H188172132 JULY 2009 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles Used excluslvely <br /> �Agricultural/Horticultural �Educational ❑Religious ❑Charitable �Gemetery as indicated? <br /> Give detailed descriptlon bi use,including an expianation if multiple use classificatipns exisT: �YES �NO <br /> 2008 DODG�CAf2AVAN-COUNCIL OP�RATIONS <br /> 1996 GMC-RURAL DONIPHAN-USED FOR YEAR ROUND CAMP MAINTENANCE AND �0"9"`� /�► � <br /> SUMMER CAMP ` ,�r'�,.�i���� <br /> D EC 1 9 �011 <br /> � <br /> Un er enalties oi law,I declare that I have examined this application and chat it is,to the best of my knowledge and b ief,true,complete,and correct.I j <br /> al declare that I am dul orized to sign this exemption application,and that the organization owning the above-list d property doas n619�F.rG�Q�7Y <br /> In erY�bership or p q based on race,colpr,or national origin. �p�A5�1R�R8 pFF10E <br /> Gr'ANC7`:"�.AND,NEBRASKA <br /> sign SCOUT EXECUTIVE 12-16-11 <br /> here A horized ignature Title Date <br /> FDR CQUNTYTREASURER RECpMMENDATIpN <br /> DAPPROVAL COMMENTS: ��J.I���S ����'O� .,__,,..•- <br /> �]DISAPPROVAL <br /> �_., <br /> \ _,! f,.rui�-�'��a �a �..Z�'f.��� <br /> Si�re of County 7reasurer � Date <br /> FOR COUNTY BOARP nF E�UALIZATION USE ONLY <br /> �APPRpVAL COMMENTS: <br /> []DISAPPROVAL <br /> ���� <br /> uthorized ignatur Date <br /> Nebraska Papartrnent of fievenue Authorized dy Neb.ReV.St9�.§§77-202(7)(c)and(d),and 60-3,185,and 60-3,189 <br /> 86-253-2008 Rev.8-2011 Supersades 9fi-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A CdPY FORYOUR RECOR[lS. <br />