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.70/3
<br /> Nebraska of Application for Exemption FORM
<br /> Nebraska 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 /> • GRAND ISLAND DIVE AND RESCUE TEAM ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 3107 WOODRIDGE BLVD 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 /> ,Pic EsiDC1c/r OA via L.Esieeue✓,/.1/23 CZ-4=2,4s 4i/a/ 62.wh isc.9<eh ,C/E t,&?OI
<br /> V,e ,'q es,/D, -AJr Ttif C�2RP cs wet; S/O C/ ST Gewit /sc..o,cso/X/F 6.56:70 /
<br /> Ste ere crew V -/.tic Is/cc cn' 4hZ, 1446;/oce r'4vs//-A4AID /st4.'..4 Aa é 3
<br /> 71eP.,45.64(-,E. P9r in/.. -4-c,4.4(1 3/07 IA/tooa MI c./= /3L vo c ,9U/D Az 4440/K4,950/
<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 I Date of Acquisition,
<br /> _ _ if Newly Purchased
<br /> ( /6-LL L'Aef e-3 3241do13WEJ z/77t/r>'T4ite e /1,47r ocorze3ao 390? f4 St,rfZ.
<br /> 7003 /-Z?-08 8X3
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> A ricultural/Horticulturai Educational Religious Charitable as indicated?
<br /> ❑ 9 ❑ ❑ g ❑Cemetery
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: OYES ❑NO
<br /> T/5 1 1'/±/[a c ,e 5 4/5-CO _I a fl sPolr_A✓e-_l a-sez/e evu/P e41T
<br /> If No,give percentage of exempt use:
<br /> •.PrOvi-,.. 2ue4c..ri a- S77QZZV'/m.. 4 ,a.-/A i6LA;.di //S To p cjV k qr to
<br /> ,tCt4? . AAGC/ltcur .5''E-7-/C- Ai AWL) A2ou�/p_d44-4015LA D NE
<br /> /I'JA/ A/.--co /fc asset rave rm!F7E..E /AnT17 //Al/.//445 CL4SSCS 41450
<br /> 7-1/ C2447 0 /SL/¢-U/.> /✓E ,4 cii> OTZ/Er CCC*S," / OI//A/S
<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 membe ip or em• •ym, base. •n race,color,or national origin.
<br /> sign T
<br /> �, yy//�I /ec�su,e�- iz --l-/z
<br /> here Authorized % �e // Title Date
<br /> I pF �/- n -t COUNTY TREASURER RECOMMENDATION -
<br /> [L�P'PPRO/AL RECEIVED CL�viMENTS: .-^//7,,?` �/ /f-'25 - 77- sfdc€
<br /> ❑DISAPPROVAL - 4 2012
<br /> ' „ 99 aC X /a?- 9'- '2.
<br /> HAL!.COUNTY Signature o_f County Treasurer Date
<br /> 'Mr/.c iPedRS OFFICE
<br /> c p.',H)15L 4ND.NEFRASK LINTY BOARD OF EQUALIZATION USE ONLY
<br /> Bil APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<br /> • \ta -_ c7Ld/ice -ai i-/� l'-'1S7:404.34
<br /> Authorized Signature "Ur Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(c)and(d),and 60-3,185.and 60-3,189
<br /> 90-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.6-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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