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di i$ <br /> irzr Application for Exemption FORM <br /> Nebraska Department of <br /> REVENREVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> UE G •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> THE SALVATION ARMY ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 818 W 3RD ST HALL ❑Other(speciy): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION a <br /> Title + /7 . Name,Address,City. <br /> ,aSlate,Zip Code `1 ` ' <br /> C erns Waste' Gam. \&Lk\∎o `` `to-` 11s tttc io n3 CA. Gro..1v� tcLnd AJt L1843 <br /> t�°�3 G.CGce c C . Iry vs \' f�\ S$7 S .,a u-. G,ro J ta-.,4 ru C 4Sgo3 <br /> e,v ss r•i Gas"_alt. 0.-h-A,0_04‘•. k i <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make - Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> K i a 62 0 0 (0 S V SEA kL1014624356604 51514 <br /> C;he.vro 14A .2 ail '1 nowt Sp1. u+I. IGNKRGE4k83 7.679S lo <br /> 1nevro its ga G I0 Expx-ses do. " 16A114lpGSA It345a5 <br /> Ford 2 0 a 9 an.,.,e.—.4.1 e.... 1FOWE35L.89oA809sb <br /> 1x98 1 998 -Try c.v.. tcsioa8WvA 012811 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agncultural/Horticultural ❑Educational ig Religious 04 Charitable ❑Cemetery, as indicated? <br /> Give detailed description of use,including <br /> [+a a an explanation.if multiple use classifications exist: 1 1'G.K y,4 0—h a ES ❑NO <br /> strop 0. pto eke "gym e-M4-1-ctS• c)-""k Conn Yvsv.r 4.1 tteas.If No,give percentage of exempt use: <br /> (A$tct Sor . a;sos4 -5 5,...ON a-s t‘oaaI, '(4er'�o. LuGS• t,4e. q <br /> 1� r d2 dt1:v�' otk, c\o#t'. -y 8'•. vi -Inert. <br /> W p:so "pv�` ko.A‘ (':.rµa.Cs a...a e S+r,.,r.5 �.e.A'1r4cl - <br /> Wt- P`so C J p U <br /> tozvai- <br /> - .enalties of I: hat I have ex= ' ed this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also decl' zed to sign this,.-motion application,and that the organization owning the above-listed property does not discriminate <br /> in membe based on race,co., or national origin. <br /> sign►•_ eo�.SD0u�— //-- 7- go)3 <br /> here Au" ' �—� lild-ion to tea 1 0. 390-4.201 Date <br /> _______ !• ' = - TREASURER RE OMMENDATION• <br /> • CEIV • Af as: 77-2•70-2- <br /> J APPROVAL 8 COMMENTS z-i <br /> ❑DISAPPROVAL NOV 8 2013 , I <br /> • <br /> HALL COUNTY 1 Signature of County Treasurer Date <br /> GRAND ISLAND,NE, - 'e'' TY OARD OF EQUALIZATION USE ONLY <br /> $APPROVAL COMMENTS: ' <br /> ❑DISAPPROVAL . <br /> . 1 r' e_C--> /-/'f,0/c <br /> Authorized Signature ale <br /> Nebraska Departrnent of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(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 />