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Nebraska Deportment Application for Exemption FORM <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 /> • HALL COUNTRY LIVESTOCK IMPVR ASSN Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 700 E STOLLEY PK RD/ PO BOX 490 HALL ❑Other(specify): <br /> City Slate 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 /> PRESIDENT TOM DINSDALE PO BOX 1528 GRAND ISLAND NE 68802 <br /> 1ST V—P STEVE KUNZMAN 2408 RIVERSIDE DR GRAND ISLAND NE 68801 <br /> 7Nn V-P STEVE DOWDING PO BOX 5315 GRAND ISLAND NE 68802 <br /> 3RD V—P MONTE V—P 4019 NORSEMEN GRAND ISLAND NE 68803 <br /> SECRETARY GREG BAXTER 2121 N MONITOR RD GRAND ISLAND NE 68803 <br /> TREASURER DESCRIPTION OF THE MOTOR VEHICLES STEVE HANSEN 1420 STAGECOACH RD <br /> •Attach an additional sheet,it necessary. G I N68801 <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> CHEVY FLEETSIDE PICK UP 1999 PICKUP 1GCGK24J2XR/18453 OLDER VEHICLE <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> AgricuituraVHorticultural ❑Educational ❑Religious TCharitable ❑Cemetery as indicated? <br /> E <br /> Give detailed description of use,including an explanation if multiple use classifications exist DYES ❑NO <br /> THIS PICKUP IS APPROVED EVERY YEAR BUT WAS LEFT OFF THIS YEAR <br /> • BY MISTAKE. If No,give percentage of exempt use: <br /> 4—H ACTIVITIES, COMMUNITY ACTIVITIES, PROMOTIONAL ACTIVITIES OF <br /> AN EDUCATIONAL OR CHARITABLE NATURE, HORSE RACING & AGRICULTURAL ?VENTS <br /> INCLUDING THE HALL CO FAIR THE NE STATE FAIR AND STATE 4—H HORSE 3HOW <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 ( yt (44- 41,1-44J2.1 ( XEC V—P & CEO 1/16/14 <br /> here Authorized Signature I le Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ROVAL RECEIVED. <br /> MENTa: tistrYa`t i "424-•'l4 it-"ert 77 ac <br /> ❑DISAPPROVAL <br /> Signature of County Treasurer Date <br /> � �S <br /> CCU <br /> N�NTY BOARD OF EQUAIJZATION USE ONLY <br /> %APPROVAL RED <br /> 1t(IAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> r de <br /> at <br /> • !w C t {o � s?D!/f <br /> Authorized Signature e <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(c)and(d),and 603,185,and 60-3,189 <br /> 96-253-2006 Rev.6-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />