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020/9 <br /> my-1—Z=• 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 /> OVERLAND TRAILS COUNCIL BOY SCOUTS OF AMERICA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2808 O'FLANNAGAN ST HALL ❑Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Ex.Board Pres . Ron Vonderohe, 4218 Michigan St. , Grand Island, NE 68803 <br /> Ex.Board Sec/SE David Plond, 1519 W. Division St. , Grand Island, NE 68801 <br /> Ex.Board VP /Memb.Tim Jacobi, 200 W. 6th, Hastings , NE 68901 <br /> Ex.Board VP/Prog : Dan Wicht, 121 Redwood 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 BodyType Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> GMC 1996 Cargo Van 1GTFG25RXT103305 <br /> Dodge 2008 Mini Van 1D8HN44H18B172132 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturalMorticuhural ]Educational ❑Religious ❑Chartable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO <br /> �doOS" Qo - GsA&cz� 2n SccoS opec iofl5 aCcoE <br /> 2-IR coo Ae5 If No,give percentage of exempt use: <br /> GnIC --- Cavtp (-) 1-1 to - flontpban metal Cable <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,col., atonal origin. <br /> sign .3.1_ / ■- I!4 Seov.\- Ejer 'rte 66/7/13 <br /> here Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> -"7' �`,- <br /> L9 APPROVAL COMMENTS:•' �e--9'7 'C 14—' CJs S <br /> ❑DISAPPROVAL <br /> 1c—gfy, eA-st- /,-.1"—` / <br /> • Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ]APPROVAL COMMENTS: <br /> n❑DISAPPROVAL fc <br /> • Authorized Signature " - ate <br /> Nebraska Department of Revenue A,thonzed by Neb.Rev.Stat.§§77-202(11(e)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 />