Laserfiche WebLink
. _ 07OL3 <br /> Ne^--Z - Application for Exemption FORM <br /> braska 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 /> • GRAND ISLAND REACT INC <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1624 ST PAUL RD PO BOX 894 HALL D Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Z o)Z +ocT7z-c y , Name,Address,City,State,Zip Code <br /> 1-1,e...-5. Ro,g_ w„Kc-> -,Ax - A2- y sr 114, 4 C l ‘sb0 f <br /> ,.c ('RA/ a Lici LLkwetZ /0•-f C L1/LRti Ca ) L.no / <br /> %I?-FAS fr7,c y,d ,sZ )Y,Vank 2771 oil-AAI/JA6Lk7 C,/ 6533 C) ? <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 Date of Acquisition, <br /> it Newly Purchased <br /> CWct) o$Go5c'7011 / 97q (00 PASS (acts C' Sr 629 VILa6/5 ReAcar <br /> CSC HSic 7LAT J <br /> Exempt Uses of Motor Vehicle: tom, Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational Li Religious )f� fharitable 0 Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ,SYES 0 NO <br /> -Tp h1v13LE EniEf2GEPCy comm kk), cA�Cn) CEA-1 — a2 <br /> SE /N D/345 eet 4J. D\c+R Commuur7Lj eVEwrS If NO,givepercentage of exempt use: <br /> U a s �A Sc / <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 membership or employment based on race,color,or national origin. <br /> sign N :".re�7 73 Sias' 12. i ' i I <br /> here I Authorized Signatur 7`�/ Title Date <br /> _, / - FOR COUNTY TREASURER RECOMMENDATION <br /> [g APPROVAL. COMMENTS: AIS S '"77- QC <br /> O DISAPPROVAL <br /> Signs ure of County Treasurer Date <br /> �_z+a�3 2012 R COUNTY BOARD OF EQUALIZATION USE ONLY I <br /> 71-APP Du, 1 4 2012 OMMENTS: <br /> 0DISA•-ROVAL UL <br /> „p,LLC ofFICESA _7y//J L <br /> • TREAS iDuet RA �o•i /'/«�0� <br /> SLA <br /> GRAND i' uthonz Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(0 end(d),and 60-3,185,and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />