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— Application for Exemption FORM <br /> Nebraska Depamnem of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> amminamosein •Read Instructions on reverse aide. . <br /> IllApplicants Name Type ot Ownership <br /> GIRL SCOUTS-SPIRIT OF NEBRASKA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2400 WILDWOOD DR HALL ❑Other(specfy): <br /> City State tiro Code Slats whore Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OPINE NONPROFIT ORGANIZATION <br /> Title Name,Address.City:State,Zip Code <br /> Cp.rnII Bn..rjer _ ' Ccs\M-SAY ., 5'- / west/ccQeh,r (Ile 6;7 453-a-o3 <br /> tea: - rnA. - _ - 1-4 e . h_ A ... ...• _ ;40 <br /> - . .. a IlliarAMMIlrflIEK A AA A.. — • 4.!_ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Atbseh an additional sheet N necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Bayrype Vehicle ID Number �MhA sition,n,Purchas <br /> c\NearyP1,cktii, /999 ftci. u1 ire,o /GCEk/NZR/vC-/aniceSo <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used reclusively <br /> ❑AoriculturaVHorticultuml prEarntlonai ❑Religious ❑Cnaraable ❑Cemetery as indicated? <br /> Gibe detailedd description of use.including an explanation'd multiple use classifications exist -/ / ®VES ❑NO <br /> fir; ///o'v e S t�0 i/I/ / r /ct LA i -+I.-F-Q /• ✓r'1 Lc c (LC)U 0 alp" It No,give percentage of exempt use: <br /> / Cc r p sup PIys , qre (c,w.p G-eQc v <br /> Sc.e.Cccaw,,, —3ot- 3s-o-6tok <br /> Under penalties of law.I declare that I have examined this application and that It k.to the best of my knowledge and beset,tan,compete.and Correa I <br /> also declare that I am duly authorised 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,ant.or national origin. <br /> sign �f'- r�2 gi, ��c,tiW m �0.^pev- / 090 --2U/y <br /> here Signature The l Date <br /> I FOR COUNTY TREASURER RECOMMENDATION <br /> /5:41'ar2 41:5:e5 is 77- c ' <br /> Er APPROVAL j0 SCINV 1SV3 CIDOMMEN ra: ���� <br /> Amnon TTVH <br /> 0 DISAPPROVAL <br /> ?1 ttOZ Z £ Mir k U � = / a.9--"y of County Measurer Date <br /> FOR�R COUNTY SCARD OF EQUALIZATION USE ONLY <br /> APPROVAL Q3AI3O3. Lan, <br /> //❑oo DISAPPROVAL <br /> Authorized Slanahire Date <br /> Nebraska Dspavenux of Revenue xuewdud by Nee Rea Stall n-2211x0)end(di.and 603.l85.area 604.189 <br /> 96.263-2006 Rea.52011 Supersedes 06.263-2006 Rat.5-2619 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />