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<br /> 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 /> • HALL COUNTY LIVESTOCK IMPROVEMENT ASSOCIATION FONNER PARK ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 700 E STOLLEY PARK RD PO BOX 490 HALL 0 Other(specify):
<br /> City State Zip Code Slate Where Incorporated
<br /> GRAND ISLAND NE 68802 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title PRESIDENT Name,Address,City,State,Zip codeKEITH JARDINE,168 PONDEROSA CT, GRAND ISLAND, NE68803
<br /> 1ST VICE PRESIDENT TOM DINSDALE, 1919 WEST LAMAR STREET, GRAND ISLAND, NE 68803
<br /> 2ND VICE PRESIDENT STEVE D KUNZMAN, 2408 RIVERSIDE DR, GRAND ISLAND, NE 68801
<br /> 3RD VICE PRESIDENT STEVE DOWDING, 4417 DRAKE LANE, GRAND ISLAND, NE 68801
<br /> SECRETARY MONTE V HEHNKE, 4019 NORSEMAN AV, GRAND ISLAND, NE 68803
<br /> TREASURER GREG BAXTER, 2121 N MONITOR RD, GRAND ISLAND,NE 68803
<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 /> if Newly Purchased
<br />•
<br /> SEE ATTACHED LIST OF EXEMPT VEHIC,ES
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> Agricultural/Horticultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated?
<br /> Give detailed descri tion of use,includin an ex lanation if multi le use classifications exist: YES fl NO
<br /> 4—H ACTIVITIES, COMMUNITY ACTIVITIES, PROMOTIONAL ACTIVITIES
<br /> OF AN EDUCATIONAL OR CHARITABLE NATURE, HORSE RACING, AND If No,give percentage of exempt use:
<br /> • AGRICULTURAL EVENTS INCLUDING THE HALL COUNTY FAIR, THE
<br /> NEBRASKA STATE FAIR AND STATE 4—H HORSE SHOW
<br /> 1" crtefER 3-k-30% -3 Z-
<br />• ysrs
<br /> Under penalties of law,I declare that I have exalnined 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 /> 2_o
<br /> here 1•>�LA-44, EXECUTIVE VICE—PRESIDENT & CEO 1 I '— ' I ' O
<br /> here Authorized Sigrdature Title Date
<br /> FOR COUNTY TREASURER RECOMMENDATION
<br /> APPROVAL RECEIVED )OMMENTS: 4StrenfrestilatS' pr- So a
<br /> DISAPPROVAL
<br /> NOV 1 4 2012 0- ds-e)1 '"oiv,
<br /> I'Signature of County Treasurer Date
<br /> HALL COUNTY FO i COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> Torn SI targis nrPMP
<br /> GRAND ISLAND,NEBRASKA ,
<br /> APPROVAL COMMENTS:
<br /> DISAPPROVAL
<br /> uthorized Signature Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)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 />
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