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U14 <br /> is r. <br /> tee.--Z— Application for Exemption FORM <br /> Nebraska Department of <br /> REVEMJE 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 Applicants Name Type o1 Ownership <br /> GIRL SCOUTS SPIRIT OF NEBRASKA ®Nonprofit <br /> Street or Otner 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 /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year I Body Type Vehicle ID Number if of Acquisition, <br /> sased <br /> HOME MADE CANOE 1980 _ CANOE TRAILER HOME MADE <br /> HOME MADE CANOE 1984 CANOE TRAILER HOME MADE <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ® Educational El Religious El Charitable ❑Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist CITES ❑NO <br /> • TRANSPORT GIRLS AND ADULTS TO EVENTS AND CAMPS. TRANSPORT If No,give percentage of exempt use: <br /> EQUIPMENT AND CAMPING EQUIPMENT, PURCHASING FOOD FOR GIRL SCOUT <br /> EVENTS. % <br /> Under penalties of law,I declare": ave 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 au orized to-'•n this exemption application,and that the organization owning The above-listed property does not discriminate <br /> in i mbe ip or employme t based on r. e,cola or national origin. <br />• <br /> r <br /> sign Ca) i\Wzl t3 <br /> • <br /> here (Authorized ignature Title Date <br /> J FOR COUNTY TREASURER RECOMMENDATION <br /> '//'te�aa „4jYc'/ d ' .4---r `*77 _-—2..__ <br />• ❑APPROVAL RECEIVEYOMMENTS: <br /> ❑ DISAPPROVAL <br /> NOV 2 7 2013 j� ;:�: 4 J`' /.. 3.. /Z. <br /> emu'' <br /> • Signature of County Treasurer Date <br /> HALL COUNTYFOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TReASunER,OFFN* <br /> GRAND ISLAND,NEBRASKA t <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / Mc z.L tQ2 <br /> • it Authorized Signature --------_. Date <br /> Nebraska Departmental Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(C)and(d),and 60-3,185,and 60-3189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />