Laserfiche WebLink
, a <br /> s+^�— Application for Exemption FORM <br /> Nebraska Depanmem 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 /> HALL COUNTY CIO SENIOR CITIZEN INDUSTRIES,INC. ®Nonprofit <br /> Sheet or Other Mailing Address County Corporation <br /> 304 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 OFTHE NONPROFIT ORGANIZATION - <br /> Title - Name,Address,City,State,Zip Code <br /> **SEE ATTACHED LIST" <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> BRAUN HANDICAP • 2014 VAN 2C7WDGBG6ER220356 4/23/14 <br /> BRAUN HANDICAP 2014 VAN 2C7WDGBG4ER220355 4/23/14 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation It multiple use classifications exist: ®YES ❑NO <br /> Provide public transportation of the eldedy, handicapped, and general public within Hall <br /> If No give percentage of exempt ace: <br /> County. <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 net discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign U -moo-i� <br /> here Authorized Signature / Title Date <br /> ,,��,,,,��'' FOR COUNTY TREASURER RECOMMENDATION <br /> LNJ APPRO4iL 4VIVlAENTS: /�'-- �•� N �' �� <br /> RECEIVED <br /> ❑DISAPPROVAL <br /> 2014 Q�G 2-1-/Are <br /> MAY 2 3 i1 Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> APPROW GRAND ISLAND.NEBRASKACOWENTS: <br /> ❑DISAPPROVAL <br /> •Authorized Signature <br /> Nebraska Department of Revenue Authorized by Ned Rev.Stat.§§77-202(1)(0 and(d),and 80-3,185,and 603189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />