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eke Application for Exemption FORM <br /> Nebraska Depanment of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> pplicant's Name Type of Ownership <br /> GRAND ISLAND DIVE AND RESCUE TEAM ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3107 WOOD RIDGE BLVD HALL <br /> ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ieESloa'r Davies Le%14? aC //Z3 6 Areesepa Are, GS4..us /state 4/C68801 <br /> c J' toed/ ✓ 'G W _ ' O e Sr 1_ -- - . .se <br /> it/ mo d.' '!:/.'. • - --. • _ • ._ ,..fiD <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 /> it Newly Purchased <br /> ideL.0 s 4,4260 dilL/rY TKAiteP Lwe7mF7g311O39 0? <br /> - 324408c0t3- /-23-o3 -81(39/9 <br /> ZOO'? <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaUHonicultural ❑Educational ❑Religious Charitable ❑Cemetery <br /> as indicated? <br /> Give�etailed description of use,including an explanation if multiple use classifications exist: IYIYES ❑NO <br /> .. /#/5 ,Y4'GEYZ. lS uweR-70.. neg'.S.kyer /J/ve- /2E-3-WC EQU/PNiet/P Y <br /> �-�O ,j24.40,44 _P126 B'J7GX1 /A/ G.e#9�/) /$t4z,/a A e maw.If No,give percentage of exempt use: <br /> .4&ocra ,set sra-p gec/ASir Scewc /•v .9. 4C O.eet,.vi/) <br /> _e..2,144,0.4c,c,ib /s/C... ..41-52-)-- /PASO /J6 C&SCO ode IAA 4lt ' <br /> . Sig/7e/.Y_ T12/9iA//.c/4 CL.4S_Se5-.JUSO-,%i d4.9A46 /ScsciiA- <br /> . /✓E AL/p o7'at. ecvsC 7z2 <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 t am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> sign in membe hip e toy t bas on race,color,or national origin. <br /> /ate �� c=,e2sz�2E /z]- /3 <br /> here i�AU[horized na Title Date <br /> FOR COUNTY TREASURER RECOMMENDwATTIIONN 1 <br /> /APPROVAL RECEIVED COMMENTS: 2, /"-t A, S ' 77 �C� <br /> ❑DISAPPRO/AL DEC 3 2013 <br /> •Signature of County Treasurer Date <br /> HALL COUNTY OF <br /> TREASURERS S OFFf <br /> R COU 4TY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> 777TTT�PPROVAL COMMENTS: <br /> ❑"'___DISAPPROVAL '�-� <br /> /Self /h "1--------- /!1/00/47‘ <br /> 0 Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(11(c)and(d),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 />