Laserfiche WebLink
e► n..—ea Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 4$7 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> pplicant's Name Type of Ownership <br /> lip CRISIS CENTER INC ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2251 N WEBB RD PO BOX 5885 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name Address,City,State,Zip Code <br /> OW a AA ► ' I s r at M, a a- • and I ,..r NE , s ;• <br /> WPM- I au . .�iii�T�.,•���� s:► <br /> -r e/su.rer _ se ' 'I ran, - , , , ,. . <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> ---- _° - - Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Cie co le+ ap O l V n+�,r Van 2 ND$O35-4IDa.13DPI <br /> �i I lace 1 a'13 a'}doorse -OeviIle 1 a b0D53 83 N3&351 I <br /> �000t e 1 qq a Ram LUa.jon 89,50 get-114 896Y5KKII-14193-1 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgdculturaUHorlicullural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give/ddetailil�ed description of incclluding/an}expllaanation if multiple use classifications,exist:: pawl/tat q-ya YES ❑NO <br /> . V&' I 1 pL.W�a Q.i/LL ctte d. y 1 Gl frrr l/a/bo 24.11 ^t{v1'7 O If No,give percentage of exempt use: <br /> •V vv V t) G/wk• a m ✓V Vw.. vt to i V 1 , fu uiv ` o <br /> C vuittuAt2 ant Ct 1,a t huts p 9-IkaA7oh tiU 4 <br /> pLtet• 3oa- 0a6o <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 duty 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,color,or national origin. - <br /> sign ,emu u P , , J EXeCuA-iY& D rerfor ul/ig/t3 <br /> here Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> �APPROVAL RECEIVED�MMEN-S: ^' �°�; N�� 177-- �` -a <br /> ❑DISAPPROVA. <br /> NOV 1 9 2013 . .-ed•ai z-g",-s<` <br /> • Signature of County Treasurer Date <br /> ppOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COLNrtY — <br /> TREASURERS OFFICE <br /> APPROVAL GRAND ISLAND.NEBRrt.,S: <br /> ❑ DISAPPROVAL <br /> it Authorized Signature —_ Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(c)and(b),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 />