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020L3 sak^—Z-- Application for Exemption FORM Nebraska Department of • 1 RE ENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 •To be tiled with your county treasurer. •Read instructions on reverse side. •Applicant's Name Type of Ownership OVERLAND TRAILS COUNCIL BOY SCOUTS OF AMERICA ®Nonprofit Street or Other Mailing Address County Corporation 2808 O'FLANNAGAN ST HALL 0 Other(specify): City State Zip Code State Where Incorporated GRAND ISLAND NE 68803 NE IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION Title Name,Address,City,State,Zip Code Exec. Board -Pres?- Ron Vonderohe , 4218 Michigan St. , Grand Island, NE 68803 Exec_ Rnard Treas. Tyson Coble . 1323 N. Minnesota Ave , Hastings , NE 68901 Exec. Board Sec. /SEDavid Plond, 1519 W. Division St. , Grand Island, NE 68801 Council Commissioner Glen Jorgenson, 315 W. 9th St. , Hastings, NE 68901 DESCRIPTION OF THE MOTOR VEHICLES 'Attach an additional sheet,if necessary. Registration Date or Motor Vehicle Make I Model Year I Body Type Vehicle 0 Number _ Date of Acquisition- - -- - - - it Newly Purchased GMC 1996 Cargo Van 1GTFG25RXT103305 3/12/2007 DODGE 2008 Mini- Van 1D8HN44H18B172132 July 2009 Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively A nculluraVHorticultural - Educational Religious as indicated? Oki ❑ g� ® ❑ g � �Charitable ❑Cemetery Give detailed description of use,Including an explanation if multiple use classifications exist: DI YES ❑NO tan JACLQL' aDLL'�Cl l C ptro--torts •19�� (?,MC - •RiWt-1 jon.tpk0..n LLacL 4r camp rt\dtrtkerpa..rsca 0- It No,give percentage of exempt use: L0. p d Un•er pena penalties of law,I declare that I have examined this a pp lication and that it is,to the best of my knowledge and be li et,tru e,complete,and correct.t.I al • • tare that lam duly authors =< .• -. lion application,and that the organization owning the above-listed property does not discriminate in - • rs • , ployme"...sect on race,co•r`, ,national origin. sign . .- ,A I Scout Executive 11/6/2012 here I Authorized Signature Title Date -- - " OUNTY TREASURER RECOMMENDATION • APPROV•L RE - CO ENTS: • /C2r-m' it/SS 77r- r�O.2i ❑DISAPPROVAL n,i — r.!� 2012 t �J: 0' //- 9_/� HAt_( c IJNTY it• Signature of County Treasurer Date r`i,.,,. ; nt�u,NL \cF=F . ••. NTY BOARD OF EQUALIZATION USE ONLY I AAPPROVAL COMMENTS: ❑DISAPPROVAL • .e,-...... .- 41A--- ...t!--0/7. ..,e--_-•- Zl frk at2 o Authoriz:•Signature r' Date Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 603,185,and 60-3.189 96-253-2006 Rev.8-2011 Supersedes 96-253-2095 Rev.5-2009 PLEASE RETAIN A COPY FOR YOUR RECORDS.