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�.� � ;�� <br /> � <br /> �-�,° . .r,., ;� <br /> ��� Application for Exemption �o�M <br /> Ne6raska bepartment of <br /> REVENUE from Motor Vehicle Taxes by Glualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> American National Red Crass �Nonpro4it <br /> Street or pther Mailing Address County Corporation <br /> 404 E. Third St Hall <br /> �pther(specify); <br /> Gity State Zip Gode State Where Incorporated <br /> Grand Island NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPR4FI7 pHGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> See Attached List <br /> DESCRIPT'ION OFTHE MOTnR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registr�tipn Date pr <br /> Motor Vehicle Make Model Year BodyType Vehicls ID Number Date of Acqe:SsltEon, <br /> if Newly Purchased <br /> Dpdge 200fi Durango 1D8MB58276F102113 11/1/2011 <br /> Ford 2009 Ambulance 1 FDXE45P19DA80312 <br /> Chevy 2001 Venture 1 GNDXp3Efi1 D30773� <br /> Buick 2005 LeSabre 1 G4HP52K95U283844 <br /> Fprd 1981 Van/Ambulance 1 FTJS34L6BHA50166 <br /> �xempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Monicultural �Educational �Religious �Charitable ❑Gemetery as indicated7 <br /> Give detailed description of use,including an expianation if multiple use classifications exist: �YES �NO <br /> The American Red Cross uses the vehicles to respond to fires and other disasters. The van, <br /> LaSabre and Durango are also used for travel to Health and Safety classes and general ' � <br /> transportation related to the Chapter. <br /> �av � � zo�� <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowladge and b ief,true,complet� ��n���� <br /> also declare thet I am duly authorized to sign this exemption application,and that the organization owning the above-list d property d��3fe1 � �p��F <br /> in membership or employment 6ased on race,color,or national origin. (3RAND le!_t•n;r7 !ti'c:BRASkA <br /> ( -� ��.,,," ' � <br /> S�gh 'VL� 4�5�vtA�� Executive Director 11/14/2011 <br /> here Authorized Signature Title Date <br /> FOR COUN7YTREASURER RECOMMENDATION <br /> �APPRQVAL COMMENTS: �S ���a"�`�' <br /> ��ISAPPRDVAL <br /> c:7 [,�,/� � ��� ) -1 \ <br /> \ !)'�1.tGd-d"/r./ �aS �o��J l� <br /> Signature oF County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALI2ATION USE ONLY <br /> �APPR�VAL CbMMEN7S: <br /> ❑DISAPPROVAL <br /> ��—/..� <br /> Authorized Signatur Date <br /> Nebraska Department of Rgvenue Autnorized hy Ne6.Rev.StaL§§77-202�1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2008 Rev.8•2011 5upersede5 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECOFIDS. <br />