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, 2073 <br /> iten--z 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 /> American National Red Cross ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 404 E. Third Street Hall ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> Grand Island NE 68801 NE <br /> IDENTIFY OFFICERS.DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name.Address,City.State.Zip Code <br /> See attached list <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year I Body Type -.Vehicle ID Numhar _._Date of Acquisition. <br /> if Newly Purchased <br /> Dodge 2006 Durango 1D8HB58276F102113 <br /> Ford 2009 Ambulance 1FDXE45P19DA80312 <br /> Chevy 2001 Venture 1GNDX03E61D307730 <br /> Buick 2005 LeSabre 1G4HP52K95U283844 <br /> Ford 1981 Van/Ambulance 1FTJS34L6BHA50166 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: 1!1 YES ❑NO <br /> The American Red Cross uses the vehicles to respond to fires and other disasters. The van, If No,give percentage of exempt use: <br /> lilasabre and Durango are also used for travel to Health and Safety classes and general <br /> transportation related to the Chapter. <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.1 <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 membership or employment based on race,color,or national origin. <br /> sign X p,_, Executive Director 11-29-12 <br /> here ■A ,orized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> Q APPROVLL RECEIVED CON.MENTS: „ow yss 77- o?� - <br /> ❑ DISAPPROVAL DEC — 3 2012 <br /> ibC Si°6Q-12-43••-le--- /e� - l <br /> HALL COUNTY Signature of County Treasurer Date <br /> AND ISc S AND,_r6r-R y o8 r !LE OR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND <br /> a <br /> 41/APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> % <br /> • /ar"213 <br /> authorized Signature e <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(0(c)and(d),and 60-3,185,and so-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 />