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—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 /> 0 Applicant's Name Type of Ownership
<br /> THE SALVATION ARMY ® Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 818 W 3RD ST HALL ❑Other(specify):
<br /> City State Zip Code Slate Where Incorporated
<br /> GRAND ISLAND NE 68801 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> �,r : G \\;o.mt lu.\ 115 L4-or...ta0,9. CA. C�,n,..,,j -'slo.nd Mt- I,WO
<br /> C s tick 14 tp4jaA \8 (S ra;9 CA. Ge...r&7�o--s, Ptltr 48843
<br /> /}'��..l,s ��c-.e.r Ge. h h
<br /> ah(v:six pi Goo-r&. tb..4- ro-cia.4kr
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> *Attach an additional sheet,if necessary.
<br />__t._.._ _
<br /> Registration Date or
<br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition,
<br /> it Newly Purchased
<br /> K; a A 06 5V SEA 1k10P1623;566tA5156
<br /> C_ha.vre, ltd � a II £t C\oerc SO. U+l. IGNKRGE ilk 8s3679S6
<br /> QJ4tvro ltA Ol V ICD Exp.-cis Vo. 1GA2f&tOGSA%%345,25
<br /> Ford .2009 an...n c.ol evel-.y1 POW E35L.8'1V .109S&
<br /> FCet8 I 1 9a8 I -rr.xcK WWON7028WVA 012811
<br /> Exempt Uses of Motor Vehicle: I� Are the motor vehicles used exclusively
<br /> ❑AgriculturaUHonicultural III Educational Educational lg Religious Chadtable 111 Cemetery as indicated?
<br /> Give detailed description of use,including(an explanation if multiple use classifications exist: pity., µ.9 &Y.d ES ❑NO
<br /> aG\rop Q(` ^ p toe1e .7,r " C.\r..,t aN ��eeo..ruk Lo. - .v.,..,:. try a 're'AS•If No,give percentage of exempt use:
<br /> LA Sea Sor cs Sa-S4�5 5,.C-�c\• o-s t\oed3, 4arn.o_d-oes, t-1c• %
<br /> Jt p;c� ✓p ry.wd1. rat\:VU' $oea., c\e#t- . c..•.rw; .}-...ce.,
<br /> \jta\S. ezcK ✓p toe'\\ (';ny,s•s 0,42 C- sk-w.,..3 \Ge...141-03 .
<br /> nal-
<br /> - .-nalties of t: ' : = hat I have ext • ed this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I
<br /> also declare ,. •i duly aut •rized to to sign this a :mption application,and that the organization owning the above-listed property does not discriminate
<br /> in membe rye m: based on race,col, ,or national origin.
<br /> sign -c�` 1.� Cio c-�,�_ //- 7- Zo i3
<br /> here Aat .ri2-. ll.o.- :a \ o: 390-4ao9 Date
<br /> I ���- - :c - • TREASURER RE OMMENDATION
<br /> i,
<br /> 111 APPROVAL CE�V COMMENTS - 475.w• .tt772 .
<br /> ❑DISAPPROVAL NOV 8 CJ L3
<br /> s- -may -e-a-°./- f-e -,---„
<br /> HALL COUNTY `Signature of County Treasurer Date
<br /> CJ S RE S OFFIC
<br /> GRAND ISLAND,NEBRSOLGII•ITY }OARD OF EQUALIZATION USE ONLY
<br /> VI APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<br /> 6 A4 f 3 --Pi 2a4
<br /> •
<br /> Authorized Signature ate
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(0)and(d),and 60-3,185,and 60-3.189
<br /> 96-253-2006 Rev.5-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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