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II .070/3 <br /> + —L-- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> • THE SALVATION ARMY ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 818 W 3RD ST HALL ❑Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,Stale,Zip Code <br /> Carps 0 r kr.n navLYhowtrS 1$1S 1.64-10-1.64-10-cot CA C.rav�8 t ta.... 0/W W 6 S°3 <br /> (Ire b sage C.-est.-4-9, 01....,r-t.3c M-6•.++ 3 t 2 LT tu...roat CA, Ctrw,.2-.2S la..../ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Dote or <br /> i Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> }5tc� 1(Al t'Q233sib69s,S6 fNewly Puchased <br /> oZOUfu SV .SED <br /> C)tevrelck , b 1 i Y haw Spt, 1 AAA. IGAIk126EMC ill.107 Y540 <br /> rC•�� aevretcF AO10 F�yorws Va» 1GA-MGID6SAI(39saS <br /> GrC. Goo '1 reMhN1 ;_4 C..i-ow -r1FDWt=3SLS10A8oISG <br /> 5,1-.11- t".18 Tcuehr tFto 763'8WYAOIa81i <br /> Exempt Uses of Motor Vehicle: �7 Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational 5O.Religious I5i Charitable ❑Cemetery 44 as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist ['�cif.. "1 a �d&t RYES ❑NO <br /> P4,ptt Zit v.. c ••••J. orw+ . t c(evs...."-....—..-/4y .tv'�"4-S_ (\\aa -•scd. Car <br /> 5.,,t—t.. a-S c:rG1,-Cta..rf-S /4.c-n-e-Jaa3 G • Wt P:C�"Id It No,give percentage of exempt use: <br /> • At:se.s <br /> gNdL Iott.t+r .c+es,.ulsh1".:i'Th. S;--r,,..),,-e-e, t,J G a.,-Jo .o: cY.. �t1 <br /> c4•na a `Cuc1/4t-3 ear\ (4-1.r' <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and belief,true.complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in mememPtoymbased on race,�br,or national origin. <br /> sign Cato,'-a);r. l 1- �- la <br /> here R Authorized Signature Title ` Date . <br /> .t}.;/ It %v t rlY�nw e.rtS a.' �1; S5 ,� <br /> IYTJN OUNTYTREASURER RECOMMENDATION <br /> ■ r. ip. 42.5„5- if 77- d7Q <br /> APPRO L CO MENTS: <br /> ❑DISAPP'OVAL <br /> ' J+V - Q 2012 <br /> MALI. COUNTY //—9.s/� <br /> T I'AS U F� '3 OFFICE my Treasurer Date <br /> OfLaP;O IS' .:..:.( <br /> f'1 OUNTY BOARD OF EQUALIZATION USE ONLY <br /> ['APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> • � _ __.- 40"-",, <br /> thorized ignature at idctral024d <br /> Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(d)and(d),and 60-3,185,and 6D-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />