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few— Application for Exemption FORM <br /> Nebreeka REVENUE et from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> REVENUE •To be Glad with your county treasurer. 457 <br /> •Read instructions on reverse side. <br /> Type of Ownership <br /> Applicam's Name <br /> HALL COUNTY C/O SENIOR CITIZEN INDUSTRIES INC. N Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 304 E.THIRD ST 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 /> Tide Name.Address.(lily,State,Zip Code <br /> "SEE ATTACHED LIST" <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 Hunter Dab of Acquisition, <br /> if Newly Purchased <br /> FORD 2013 BUS 1FDFE4F59DDA44732 _ 04/04/13 <br /> Are the motor vehicles used exclusively <br /> Exempt Uses of Motor Vehicle: as indicated? <br /> ❑Agricultural/Horticultural ❑Educational ❑Religious ®charitable ❑Cemetery <br /> d use classifications must ®YES Elmo <br /> Give detailed description of use,inducing an explanation" multiple <br /> Provide public transportation of the elderly, handicapped, and general public within Hall <br /> If No 9199 Percentage of exempt use: <br /> County % <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 carved.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization ownkg the above-listed property does not discriminate <br /> In rnembershp or employment based on race,color,or national origin. �f C, <br /> Sign 'A • • a . M- �jA . Executive Director / of I '/ 3 <br /> here tr4,11Te''nature / The Date <br /> I RECEIVED FOR UNTYTRRE MEND l4 77 ac . <br /> �]APPROVAL COMM NTS: <br /> ❑DISAPPROWL �A1 1 4 2013 <br /> .ta''Qr'°` .... rs'--ss <br /> tau o couivrt <br /> ,Signature of County Treasurer Date <br /> OMAN I)IS d` t'D NE BOARD OF EQUALIZATION USE ONLY <br /> si APPROVAL COMMENTS: <br /> ❑DISAPPROVAL /• <br /> • ._.Signature V Date <br /> Authorized by He Rev.set§§n-202(lXc)end(d),and so-atas,and 60-3.169 <br /> Nebraska.2 Department 6 Reif 8-2 11 R upeae <br /> 9szst-woe t .620i1 Srpeoeaas 96463-2006 R«.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />