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R.0/1` <br /> Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •T0 be Bled with your county treasurer. <br /> •Read instructions on reverse side. <br />• Applicants Name Type of Ownership <br /> HALL COUNTRY LIVESTOCK IMPVR ASSN 51 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 Stale 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 /> 7ND 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 OFTHE MOTOR VEHICLES STEVE HANSEN 1420 STAGECOACH RD <br /> •Attach an additional sheet,if necessary. G I N€8801 <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 1GCGK24J2XR7184S3 OLDER VEHICLE <br /> Exempt Uses of Motor Vehicle: ,, Are the motor vehicles used exclusively <br /> ®Agricultural/Horticultural Educational ❑Religious r—TCharitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation If multiple use classifications exist: YES El 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,titre,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 , 111/1 tivik71 ;' XEC V-P & CEO 1/16/14 <br /> here Authorized Signature • t • • e Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> 1 PROVAL RECEIVEDMMENTo: ^-�� -'� i°"-'-4---At' $7 414 fl —3 -7-- <br /> ❑DISAPPROVAL t r ZO/ <br /> Signature of my Treasurer Date <br /> tskis R�RS�OfAUNTY BOARD OF EQUALIZATION USE ONLY <br /> %APPROVAL O SSLLAANNDD NN COMMENTS: • <br /> ❑DISAPPROVAL <br /> 6 / <br /> it rn e a°uf <br /> • Authorized Signature ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77.202(1)(cl and(d).and 6D-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 /> I _— <br />