Laserfiche WebLink
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 /> . American National Red Cross ®Nonprofit <br /> . Street or Other Mailing Address . County Corporation. <br /> 404 E. Third Street 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.Stale,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 Number Date of Acquisition, <br /> if Newly Purchased <br /> Dodge 2013 Caravan 2C4RDGBG4DR771457 6/24/13 <br /> • <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgricutturatHonicultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an expianatiomif multiple use classifications exist: IV YES ❑NO <br /> The American Red Cross uses the vehicles to respond to fires and other disasters. The No,give percentage of exempt use: <br /> If vehicle is also used for travel to Health and Safety classes and general transportation related <br />• to the Chapter. <br />• <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 properly does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> Sign l■ `�� L, a J Executive Director 7-3-13 <br /> here A`!)T.•Signatures Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> [J'APPROVAL COMMENTS: ""'-- --)" .ente-)14°S"c 7 c7Z <br /> ❑DISAPPROVAL <br /> Qo}°C � <br /> 11 Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL RECEIVED • <br /> JUL - 5 2013 �.M, . .� Vi. 7-1/ <br /> l <br /> Authorized Signature/' . Date r <br /> Nebraska Depelment of Revenue Authorized by Neb.Rev.Stet.§§77-202(1)(c)and(d),and 60-3,185,and 6e3,189 <br /> 96-253-2006 Rev.8-2011 Supersed4SWICOUNTIF2009 <br /> tREASURERS OFFICE PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> 6RANDISLAND.NEBRASKA <br />