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" �.��� <br /> �'�--�-- Application for Exemption �o�M <br /> Nobraska�aparYment of <br /> �E�NUE fram Motor Vehicle Taxes by Glualifying Nonprofit Organizations <br /> •To pe filed with yqur county treasurer, d�� <br /> � •Read instructions on reverse side. � <br /> applicant's Name <br /> 7ype of Ownership <br /> GRAND ISLAND AREA HABITAT FOR HUMANITY <br /> �Nonprotit <br /> Street or Other Mailing Address Counry Corporation <br /> 41Q W 2ND ST#6 PO BOX 1001 g <br /> �Other(specify): <br /> Ciry State Tip Gode State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> (DENTIFY O�FICERS,DIRECTpRS,OR PARTNERS pFTHE NQNPRdFIT ppGANlZATION <br /> TitlQ Name,Address,City,State,Zip Code <br /> �`"��1 Gt�f:"l� r Iv� C--n k s er, �z 5 3 �bY`Lt l C � C�/`Cc.r�p�,.A._y(LG n c� /l�E. b r��� <br /> . P, cx�f-"Y. �r�-+�a sz-c�sk.� �3► . �Oa-� 2nP, w ao�! �.a"v-t_r � fck��f <br /> !'�`�" 1� 1 .Q7�r �G �Jp! ' r N� ��'Z <br /> (n S t.t.(`�{"' .(J�.$ - $�. Y) �I 1 P a nd�f•p 2 r"' /`!�r�a�Tr'�Ce � � <br /> DESCRIPTION DFTHE MO7pRVEWICLES <br /> •Attach an additienal sheet,if necessary. <br /> Registratipn Date or <br /> MotorVehlcle Make ModelYear epdyType Vahicle I�Number Date of Acquisition, <br /> if Newty PurChased <br /> GMC 20D8 pICKUP 1 GTEC 14C98Z9p1 p74 1-9-12 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaUHorticultural ��ducational �Religious ,�'�haritable �Cemetery as indicated? <br /> Give detailed descriptipn ot use,including an explanation if multiple use classifications exist: �5 �Np <br /> i�s p t�GK-�;•� C o�s�ru�i-7 o n r�a+ex-�o.-� C�o r�r.�1-��n.5 � 1�n e�'.--F <br /> �"7Ll�p"��Lt�f-- ��''" �VV�R-✓�-� `�`��S �C�w -iY n C C�m Q 1'10 u S�� c{ �("O G r^[c rr-� f No,give p <br /> -.) �] � �' <br /> JA N 1 1 2012 <br /> Under penalties nf law,I declare that I have examined thi5 application and that it is,to the best of my knowledge and beli ,true,complete,�I�I.�ofZ�cAi�Iry <br /> also declare that I am duly authorized to sign this exemption application,and that tha organization owning the above-liste property�p��i45t�disdrmii ' �,^:r�r_� <br /> in mem6ership or employment based on race,color,or national origin. `��'��7 ' `%+!"''.N:.�;�;t,��,SA <br /> sign �. - � - � ,.� ��.-���f-� � �� �� <br /> here Authorized 5ignature Title Date <br /> FOR COUNTYTREASURER RECQMMENpATIbN <br /> �PPROVAL COMMEN7S: �� / �',���� r'� �`��i <br /> ❑DISAF'PRdVAL <br /> r1 f <br /> � ��%` �a r ��p� %.� <br /> Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF��UAI.IZATION USE bNI�Y <br /> �APPRQVAL COMM�NTS: <br /> ❑DISAPPROVAL <br /> /�/ �J� <br /> Authorized Signalure pate <br /> Nebraska pepartmant of Revenug Authorized by Ngb.Rev.Stat§§77-202(i)(c)and(d),and 60-3,185,and fiO3,189 <br /> 96-253-2U06 Rev.8•20t 1 Supersedes 96•293-2tl06 Hev.5-2009 <br /> PLEA5E RETAIN A COPY FOR YOUR RECORQS. <br />