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- <br /> • ---z.--- 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 />• <br /> 0 Applicant's Name Type of Ownership <br /> American National Red Cross ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 404 E. Third St Hall ❑Other(specify): <br /> City State 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 /> See attached list <br />• <br /> DESCRIPTION OF THE MOTOR VEHICLES <br />• <br /> •Attach an additional sheet,if necessary. <br /> I Registration Date or <br /> Motor Vehtcie Make Model Year - Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Dodge 2006 Durango 1D8HB58276F102113 <br /> Ford 2009 Ambulance 1 FDXE45P19DA80312 <br /> Chevy 2001 Venture 1GNDX03E61D307730 <br /> Buick 2005 LeSabre 1G4HP52K95U283844 <br /> Dodge 2013 Caravan 2C4RDGB4DR771457 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agrrcullural/Horticultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO <br /> The American Red Cross uses the vehicles to respond to fires and other disasters. The No,give percentage of exempt use: <br /> if urango,Venture, LaSabre, and Caravan are also used for travel to Health and Safety <br /> classes and general transportation related to the Chapter. <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 J di/thrm Executive Director 11-19-13 <br /> here I,Authorized Signature Title Date <br /> EaCOUNTY TREASURER RECOMMENDATION <br /> APPRO\.AL RECEIVED COMMENTS: , 0>1.°7OC* At o-.S. J.-.fit Z <br /> ❑ DISAPPROVAL NOV 2 2 LU iL''. <br />• <br />• <br /> HALL COUNTY r Signatureo unty Treasurer Date <br /> TREASURERS O atenStfp R COUNTY BOARD OF EQUALIZATION USE ONLY <br /> CRPNB IS1 D, •tom <br /> —KL PPROVAL COMMENTS: <br /> ❑ DISAPPROVAL <br /> A4r <br /> Authorized Signature /al/� —01-0/4/1 <br /> Nebraska Departmental Revenue Authorized by Neb.Rei.Stat.§§77-202(1)(c)and(6),and 60-3,185,and 60-3,189 <br /> 96453-2006 Rev.5-2011 Supersedes 96-253-2005 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />• <br />