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• o7a/3 <br /> Im„ Z= Application for Exemption FORM <br /> Nebraska Department of <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 /> • GIRL SCOUTS-SPIRIT OF NEBRASKA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2400 WILDWOOD DR 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 /> Ctpp..w9p140.h9iir ''o-4. Coc h (9S / w/evehi, G. (,Y-roc <br /> C .to cvrnr. v-sk0\ s/.z/ cs 0147 on.r_NS fre &flh__ Ate)0 <br /> (poet,p 0 i.r,P..+urs, Mork Vie ft s,4n'-C <br /> • <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. <br /> Registration Date or <br /> - ---- — - - -Motor VahicieMake------ ---- Modul Year - - BodyType --- - Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> •otlf. vC,V. /998 Vets /�'gSS,3 /4twy 00in <br /> n Cf A J t-t*sV,r 'aLo0 7vti.,■a;- (or/o, %06CS/o/ ri nq 6 it <br /> 7h Clu • T-ci� '- /99X Ttrc,!1p.. U y 6 X T C-.2// 6e0/ �s-7 <br /> _.. 'VI 4---- - / 4/-_ - _. v oaf. <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> El Agricultural/Horticultural ig Educational ❑Religious El Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: �r RYES ❑NO <br /> ••�O7.NS l�orl G■ As d- Ado Its 7 �,pn-AS, (' flips N/p4 If No,give percentage of exempt use: <br /> �o sr a CG irrl?.i h 4 G eow- r <br /> Jcre 3dr 3$0- , /og <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 l - -m duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or c ploymentsed on race,color,or national origin. <br /> sign - mss • t1 , P.. /nigh //-lei- �/� <br /> here groused Signature Title / Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL COMMENTS: <br /> �K ocam' /ate" r�/SS iz ?7 7c2_ <br /> ❑DISAPPROVAL /� <br /> ��713t tarn L /2---.7,---,..2 <br /> It Signature of County Treasurer Date <br /> �s - i.y ft BOARD OF EQUALIZATION USE ONLY <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> AI <br /> i <br /> 0 HALL COUNT,- <br /> TREASUR L:l2S OFF.ICE Authorized ignature Date <br /> GRAND ISLAND,NI t - ''8q <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,end 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 />