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• <br /> _47U/3 <br /> Nebraska <br /> '� apaZntof Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> CRISIS CENTER INC <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2251 N WEBB RD PO BOX 5885 HALL _ ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,Slate,Zip Code <br /> 13oaxcU lliair On ' s : I - s -I a w K • E. Grand ( Iand N b'r . <br /> vvIGo- .Chtti r f' " •III c raLLEMMpr TATI From I- i NE 4? <br /> Set re+eLr _ a 4 sirlai. ,'T iWSt . UU e. iM711 fuPTIM 'O <br /> Lyreu. ure 1 /this eonarc ' ay 1lc ►a -van. Is ■ •)-'I / .sRoa <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type -- - - Vehicle ID Number -- - -_ Dete-el Acquisition, <br /> if Newly Purchased <br /> Yrole} ail en eV an I31.IDb(oi0-11Dal3O%1 <br /> " .. ^crt J H .55 1,1K1 H-&. <br /> Gil ''. 0.0 1193 I VI e GU pS� • ' 3. 3 11 <br /> me.macdeTV'ailer cl Fla+ bed I ei tDIb9: DNE <br /> ' 1um-I-Ine 1 9 9 B ' Bu-m9er Ira"le,r 1141C Sic Ixu3CAl+lI1 <br /> Exempt Uses of Motor Vehicle: _ .. Are the motor vehicles used exclusively <br /> ❑AgricuiturallHorticulturai ❑Educational ❑Religious OChantable ❑Cemetery as indicated? <br /> Give detailed description of use,including�an explanation if multiple use classifications exist: 1 YES ONO-FD <br /> g1 ��e n; i 1 19/4- et , r If No,give percentage of exempt use: <br /> ✓1 1VIW 1t tatter C'1 kept 14 -,'{'t pal # y r <br /> -TU alA,L n-Lou --Yb p- tA. - 0 , ! dt_,f . 422-itt <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-m duly authorized to si f this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in me •-rs ip mployment based on r, =,color,or national origin. <br /> // lnferlm <br /> sign / �, Jr 1/./is xectctI re, Dire ekr it q <br /> here /' th P-'Signal e Title Dat <br /> 1 FOR COUNTY TREASURER RECOMMENDATION I <br /> jy APPROVAL COMMENTS: rr _ `EC/ Ais s 77. 4'c <br /> ❑DISAPPROVAL <br /> ey,6a.a.A. /1-a/t-2 <br /> 11 Signature of County Treasurer Date <br /> _ _ _ •- COUNTY BOARD OF EQUALIZATION USE ONLY <br /> r ' <br /> e-APP••VAL ■ OMMENTS: <br /> ❑DISA•PROVAL NOV 2 1 2012 <br /> --er cii. _Al .� i.<�_ -ice _i�� e <br /> i4wJ <br /> HALL COUNTY 'ulhonze.Signature Date <br /> GRANDAISURERSNEBFI OFFICE <br /> Nebraska Department of Revenue Authorized by Neb.Rev Stat.N77-2020)(0 and(d),and 60-3.185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />