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Application for Exemption FORM <br /> N•brecks Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Road instructions on reverse akin. <br /> Applauds Name Type of Ownership <br /> GIRL SCOUTS-SPIRIT OF NEBRASKA ®Nonprofit <br /> Street or Other Wang Address County Corporation <br /> 2400 WILDWOOD DR HALL 0 Other( fy): <br /> City State Zip Code Stale 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 /> GA rnp 1`rv.4 pr CO C\ �5`r9/ were/<<Oetur (/v. L7 4q-d-03 — <br /> _ �. Yl�11*� � t4 _ fit. .. — ilc� <br /> - .. . I as 1, i ce. A Ii. — S n - <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle1G Number i�MyAcqu Win, <br /> C \AR,.y Pr'ckt+r7 /99a p/rkup Irv° /acek/t/zem,/aokefo <br /> Exempt Uses of Minor Wide: Are the motor vehicles used a cheively <br /> ❑ as indicated?A WwreVHoraaltural ArEaaalional ❑Religious ❑Charitable D cemetery <br /> Give detailed description of use.including an explanation if multiple use classifications exist iCF'ES ❑NO <br /> /o /27cI to Show / /�/C'In / -fl.e,e /• Lc C7i— i.C.C�o d Ck a No,giver percentage of marmot use: <br /> (C&n p S pP!ys , Anti Cuw.p G-eQC <br /> -So2.Cochnw- -3c - 3SQ-'afOk <br /> Under pestles of law,I deckle fiat I have exalted this spplcagsn and that it Is,to the best of my knowledge and belief,MW,complete,end correct I <br /> also declare that tarn duly authorized to sign this exemption appicagon,and that the organIzadon owrdng the above-listed properly does not discriminate <br /> En membership or employment based on nice,color.or national origin. <br /> sign ,/F rail Ul (aC��Y Cam/ ac,r v_ / o90 - -2o/7 <br /> here P mare U <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> �✓✓. S )6.77- <br /> APPR OVAL W 8N'ONVTSI dint Nham: � / — <br /> 2 a' <br /> 371.440 S3 rISVa LL <br /> AlNf103 TIVH <br /> ❑DISAPPROVAL <br /> tiOZ Z £ NV(' <br /> Ir �signature q Tdf Date a3liy <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> A APPROVAL • <br /> ®3A1333 <br /> /o DISAPPROVAL <br /> / — G �l <br /> Authorized Signature <br /> Nebraska ixperknwt of Revenue ANhnimd by Nab net at rf 77-2 (tXc)and(d). scales <br /> OS253 006 Rat 8.2011 Supersedes 0e253-2006 Rat Sawa <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />