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w Application for Exemption FORM <br /> Nebraska Department of 1 <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 /> applicant's Name Type of Ownership <br /> GRAND ISLAND AREA HABITAT FOR HUMANITY E Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 4 0-3A1-2NB-eT-fwe- Pe BOX�1 oei I b�l HALL ❑Other(specify): <br /> City -.5c/z_vv 2 riff SY y T-a• Stale 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 /> Itti S. r MIME"• a; e. . n-0'1 brvlsfer-? I NE bfr;'O <br /> © � r.l. s 3x15sr.A-ndre Los 6( . (I. NI-. 6,8gb3 r <br /> ��i I t t . as ate a . 211 Po Pi'4rres a, r . r NE.H&g0: <br /> %re4-curl Jali e fl rkvioksy 41+0 IQ . Part, G N E e&8o3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> I I ( Registration Date or <br /> — -Motor Vehicle Make Model Year Body Type Vehicle ID-Number Date of Acquisition, <br /> if Newly Purchased <br /> Wnrnc mark+f ale.41- 2-0 13 Z-whee.I/ opt"-, 3rZ IJ3 <br /> c Me 200 g pck-1-LP P ia-raaj ccgjciolc7g <br /> .Sets. ' w6rl<.. i `, ;/ '■ " er 0 Ii c" - 322w7ooSS <br /> oq1" - n a: r ( r _ Cr —t 'Z' N .__ • <br /> ft It +-rail' ZACs And �eA itJ(vuR4 -X2xS3C'77nJ- <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturalfHorticultural ❑Educational ❑Religious I Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: •®'YES ❑NO• Al I �I-ratters are-1c.seclpprl rl-,ankj Cr r- Sfcra e. cf Ccnslruchon <br /> • Cc .L',c nne.nt e-n Gl Suf lies a 'ryte.j art- 0it-o1craac( rixr�.ly-orrlj <br /> if No,give percentage of exempt use: <br /> 40 fra.n Spay± :'r'arf-e.r'1 rt-ts to a me,...) La.Li,td `s i-1-e . <br /> %The. 0i-IC. i-rr.ccIc. is L.Szd 4. ct-up cf elorLa ia.ts rf- fIn cc-- ,-;a.Iser^ <br /> 4o Secure y v.-+e j ..ts I, y� <br /> AO [try Li,sea ty act.-7p r1-I" ka.bite -S low-i ✓.on t, l'lrusi Dr10AYYL✓✓\ <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 duly 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 Stet_., . , . D , L.:2-A//3 <br /> here Authorized Signature T 0aJel\ntt ap$.3es.ssr(pile Date <br /> APPROVAL RECEIVE�MMEN YTREAASURER RECOMMENDATION c 1 <br /> A: ice.ce-0, ./7- aC3.� <br /> ❑DISAPPROVAL DEC 1 6 2013 <br /> ,_9-teyyr r -G J.44-+ /--3 "/Y <br /> HALL COUNTY <br /> TREASURERS OFFICE ,Signature of County Treasurer Date <br /> r,RANU ISLANU,NEW arA RIXF BOARD OF EQUALIZATION USE ONLY <br /> COMMENTS: <br /> ❑DISAPPROVAL <br /> e At ° / l CL- <br /> It Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rey.Slat.§§77-202(1)(c)and(d).and 60-3,165,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 />