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X0 / 3 <br /> ea^-- - 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 /> Applicants Name Type of Ownership <br /> • HOPE HARBOR INC <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 610 W DIVISION ST PO BOX 1544 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 <br /> r� Name,Address,City,State,Zip Code <br /> Escecu-Fiv e. lrrr4or. ITACESsaDe-LJefi 4018 Trdianheaci Dnfie 6rnna- Sslena , 1JE £8803 <br /> Pybo-d- Presider+ ju.lie Cmrtc-n+aker 4711 Gunband Place Grniid-gs Janet)IVE (o8 01 <br /> soara Vice Presidarrk- Lynn lea-H-Uan a-ia3 L_4ke wood Are C.ran.'Is keel/ klE (o$SOj <br /> r)oe rd Se 0-e_472-v-3 14.4 - Green Sc la SUUewood Ave-. C,rand Ssta.,d y f.l C- Lt8803 <br /> Cjoa..-d Tread1Lg-ter- -lennifer- f„a Par 14.05 NewrvtGo'co Ave. Grand is Lana/ki F. (a8803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year I Body Type Vehicle ID Number Date of Acquisition, <br /> - - - - -- - -. If Newly Purcrtased __... <br /> herlD, .l, . -r .li Id- n aCO(o le e ca I , eV • - . I(a34 5 r t _.a. ,. OIL <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> as indicated?❑Agricultural/Horticultural ❑Educational ❑Reli Religious ❑Cha Charitable ❑Cemetery <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ❑YES ❑NO <br /> Oar Pellicle, I'S tt d.. ao4rankrparf ran-deres-a, Crime ryW„�e,,e, f If• tr_f&4 / m'eeirir�s. Pick- 12f <br /> a�ae hRnSOO t Bona Ed Pr �Uc 7L, No,give percentage of exempt use: <br /> S4 -F rheir�bets sAe/er baSrnesr i>^ fnLr�n. � �R r>7elnbe s <br /> QothA^ -to e4nlerrhare c ld "raisin& eeminerr' -/Arovglzavf -fine <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 awning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign 7 i £Xe,flytiohve.. nVet/O I715//2_ <br /> here IlfrAathoriz Signature Title Date <br /> tU` •T t I OR COUNTY TREASURER RECOMMENDATION I <br /> I <br /> [ PPI�OVAL OMMENTS: , d »,/ r 4,5--c 9'7.-..,an <br /> nEr - 6 201? <br /> ❑DISAPPROVAL <br /> HALL COUNTY r_.�/� re I_ .4 - ..- ---e-2.—Z' <br /> TREASURERS OFFICE •, <br /> Signature of County Treasurer Date <br /> (;Rahn l`; AND NE9RASKA <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> • Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(11(c)and(d),and 60-3,185,and 60-3,189 <br /> 96253-2008 Rev 8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> i <br />