Laserfiche WebLink
Joik7 <br /> eka--c,,- Application for Exemption FORM <br /> Nebraska Department of <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 /> HOPE HARBOR INC X Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 610 W DIVISION ST PO BOX 1544 HALL ❑Other(specify): <br /> City State 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,Slate,Zip Code <br /> -e cui I ' LA 117_ • 1 • •_r, IP/-C A .s 1 . )1 <br /> [� hi r. <br /> F l , I / / tii 11e L • II I/[ / e_1 <br /> ri ' • Q' / Ai Grn <br /> TreasarP1r. p Met ndo-&CS/i in Ak-- rfln. ToveS ,pp_ '.\.l lam?' <br /> DESCRIPTION OF THE MOTOR VEHICLES F�L,LY17 W C�- -uQ ward <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date at Acquisition, <br /> It Newly Purchased <br /> I. •. i .. a'l'_ is . ,_a • • V - ' •,1jf .•". 1 i&4 ,S <br /> Exempt Uses of Motor Vehicle: ���}}} Are the motor vehicles used exclusively <br /> El AgriculturaUHorticultural 111 Educational ❑Religious ICI Charitable ❑Cemetery as indicated? <br /> Give detailed <br /> descriptiionnofusse,including an explanation if multiple use classifications exist: NYES El NO <br /> i a i e- do! L tQ LJ lb and -c rom p 1 s z Take. t det2iQ <br /> If No,give percentage of exempt use: <br /> +C) a0eir eYVF3 . 11.52— -For Sherr i3 fSe4- Mare <br /> aciaGgai l Ory -+a r resident-3 , P i cKr u p mod i- Other <br /> ,+ems -Per re3 cdefrt5_ ec - Ym`o'cleni5 -to i1.6u-S1nt <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 /> here , l ii . _An__ EXeC Ve Nree#ar <br /> 1 Jere Authr riz-:Signature Title Data <br /> FOR COUNTY TREASURER RECOMMENDATION - J <br />• <br /> [APPROVAL RECEIVEDMMENTS: Z % ��� apr7_7Ea <br /> ❑DISAPPROVAL <br /> DEC 1 7 2013 a' -e* 7_.3-i=/ <br /> • Signature of County Treasurer Date <br /> TRCAOUHALL RCOUNTCRS O T'I ghIVOUN BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> IIAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / ///(17-. <br /> Autfwrizetl Signature ie41r /ift <br /> Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.g 77-202(t)(c)and(d),and 60-3,185,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 />