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X0/17 gry-n,.---.._- Application for Exemption FORM Nebraska Department of REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 •TO be filed with your county treasurer. •Read instructions on reverse side. pplicant's Name Type of Ownership GRAND ISLAND REACT INC ®Nonprofit Street or Other Mailing Address County Corporation 1624 ST PAUL RD PO BOX 894 HALL ❑Other(specify): City State Zip Code State Where Incorporated GRAND ISLAND NE 68802 NE � IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION Title Z a i 3 o'71'r Gr R s Name,Address,City,State,Zip Code /1 PR et S RPM/ Win}a2,4/Ax , L29 U 57 P 4 C ( L- f o / /.eE'AS mic./�4r2mye—Q,5 Z1z4. cc(4),AiAAAGAx/ c 1 6$ 503 DESCRIPTION OF THE MOTOR VEHICLES •Attach an additional sheet,if necessary. Registration Date or Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, it Newly Purchased cHty o c()58709 '17 ') loo 1hs5 Bus C5 GZLIV1 (,24/5 Rct,cT I P ec5 9 etfii Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively ID Agricultural/Horticultural El Educational ❑Religious 71 Charitable ❑Cemetery as indicated? Give detailed description of use,including an explanation it multiple use classifications exist: , NYES ❑NO o$�(.E En, 9tMC? �A'NmuA//CA�OA, CCAnrQ a02 l �/ /1 r If No,give percentage of exempt use: S L 1 au � )S QST�� Re 5%rr,.b"� c rvq)�ro dZ l,o M yn.. �I Ev auyS 4. Under penalties of law,I declare that I have examined Ihis application and that it is,to the best of my knowledge and belief,true,complete,and correct.I also declare that l am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate in membership or employment based on race,color,or national origin. sign � 7,,,,.«,r� - ��A $ /i / / 3 here thonzed Signature Title Dat r ,r IVEDOR CO Y TREASURER RECOMMENDATION /APPROVAL COMMENTS; � Z �i � 5 ,' .:2C ❑ DISAPPROVE L NOV 1 5 2013 HALL COUNTY � tYe2 —cA TREASURERS OFFICE Signature on County Treasurer Date GRAND ISLAND.NGGRASKA a rvn t.wn Y BOARD OF EQUALIZATION USE ONLY I}p APPROVAL COMMENTS: ✓D DISAPPROVAL /3-ere AI l - / —1/4)o/41 it Authorized Signature Date Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,169 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 PLEASE RETAIN A COPY FOR YOUR RECORDS.