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• <br /> Nabraskae oeaacmentol Application for Exemption FORM <br /> REVENREVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> UE •To be filed 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 /> I City State Zip Code State Where Incorporated <br /> Grand Island NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tine Name.Address,City.State,Zip Code <br /> See attached list <br />• <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 Number Date of Acquisition, <br /> _ if Newly Purchased <br /> Dodge 2013 Caravan 2C4RDGBG4DR771457 6/24113 <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: kr,YES ❑NO <br /> If IrThe American Red Cross uses the vehicles to respond to fires and other disasters. The No,give percentage of exempt use: <br /> e <br /> is also used for travel to Health and Safety classes and general transportation related <br /> 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.I <br /> also declare that l 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 As <br /> ■ 'l `i& , Executive Director 7-3-13 <br /> here Au .,- =d Signatures Title Date <br /> FOR COUNTY TREASURER RECOMMENDA TION <br />• <br /> RAPPROVAL COMMENTS: ,arirt�'4-?y/"5-- ` <br /> 77-..2.02--i <br /> ❑DISAPPROVAL <br /> `..eyj7,o�6�.��-> 7- r-,C <br /> Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL RECEIVED <br /> a <br /> JUL - 52013 ed-i,- s.'7�&e,: ._� - ter- l//� <br /> Authorized Signature " . Date <br /> Nebraska Cepolment of Revenue Authorized by Neb.Rea SOI.§§77-202(11(e)and(dl,and 60-3,185,and 60-3,159 <br /> 96-253-2006 RN 8-2011 Supersede -2009 <br /> ',MEASURERS' onto PLEASE RETAIN A COPY FOR YOUR RECORDS.NEBRASKA <br />