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29/42 <br /> •m en--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 /> • <br /> Applicant's Name Type of Ownership <br /> GIRL SCOUTS SPIRIT OF NEBRASKA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2121 S 44TH STREET HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> OMAHA NE 68105 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br />• CEO FRAN MARSHALL,2121 S 44TH STREET,OMAHA,NE 68105 <br /> 1 <br />• <br />• <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 /> FORD VAN 1998 VAN 1 FBSS31 L4WHB00125 <br /> ENCLOSED TRAILER 2008 TRAILER 6'X 10' 1 DGCS10138M081611 <br /> I ENCLOSED TRAILER 1999 TRAILER 4'X 6' 4X4TSE211XN019853 <br /> FLAT BED TRAILER 1997 TRAILER 24' 44NFH1626VL021679 <br /> CHEVROLET 1992 PICKUP 1GCEK14Z8NE120850 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ®Educational ❑Religious El Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: 1;1 YES ❑NO <br /> TRANSPORT GIRLS AND ADULTS TO EVENTS AND CAMPS. TRANSPORT <br /> If <br /> . EQUIPMENT AND CAMPING EQUIPMENT, PURCHASING FOOD FOR GIRL SCOUT No,give percentage of exempt use: <br /> EVENTS. '° <br /> Under penalties of law declare tha.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 mly authorize, o sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in •-mbership or em'loyment based in race,color,or national origin. <br /> I <br /> Sig �.• ' C 11 il3 <br /> here IAuth•� All Signature Title Date <br />. _ FOP Q9UNTY TREASURER RECOMMENDATION <br /> RECE WED ,l , ,` ,,, . . cr a'77-,7e.2 <br /> APPROVA_ COMM=NTS: <br /> ❑DISAPPROVAL NOV 2 f LO C,r <br /> HAI I COUNTY iii.Signature of County Treasurer Date <br /> TREASURERS OFFI COWTY BOARD OF EQUALIZATION USE ONLY <br /> ��// <br /> GRAND-tOLAND,N <br /> 1�4APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> fit h--/y o/�L <br /> 0 /Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)ano(d),and 60-3,185,and e0-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 98-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />