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R E <br /> Application for Exemption FORM <br /> Nab:este Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit OrganizationsNOV 2 q 457 <br /> •To be filed with your county treasurer. (� Q 2U14 <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> AMERICAN RED CROSS F J.RICHTER® 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 /> * . . <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make I ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> _ if Newly Purchased <br /> 7-e} Font a OBl E. I-)SO IFoyflsP)9 ge3i-2 <br /> P I rvi 1 9776' Ve y ater JPiI& Pau 9i3WPd fig 744 <br /> D - . oib D.,,-et,Nrp /DKH13s-2 7-6):/0,• //3 <br /> '' .. .e _ - a _ .- lir — <br /> Exempt Uses of Motor Vehicle: 10 Charitable the motor vehicles used exclusively <br /> ❑AgricuturalMareadtural ❑Educational ❑Religious "I Charitable ❑Cemetery as Indicated? <br /> Tst I •Give detailed description of use,including an explanation if multiple use classifications exist: - �� YES ONO <br /> 1t If No,give percentage of exempt use: <br /> y . % <br /> _.4.:7— G P P - , -��'`°'f /z2a rJ <br /> Under penalties of law I r.•• - 1.ye examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> alsodegarethat-ram duly authorized to sign - emotion application,and that the organization owning the above-listed properly does not discriminate <br /> in•mEinbership or employment based on race,co•r,or national origin. <br /> —l_ <br /> Si I -. <br /> here Authorized Signature -Title late <br /> FOR COUNTY TREASURER RECOMMENDATION �f c- <br /> [I set <br /> 77-PPROVAL COMMENTS: n A"' " s.`�. 2O2 <br /> ❑DISAPPROVAL RECEIVED <br /> DEC4 2014 • Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> •,.I., HALL COUNTY <br /> APPROVAL TREASURERS OFF(QUMMENTS• <br /> GRAND ISLAND,NEBRASKA <br /> ❑DISAPPROVAL <br /> .7�1�i°�_ � /� /-/3 -15 <br /> Morized • Mu Date <br /> Nebraska Department at Revenue Authorized by Ned Rev.Stat.§§77-202(1)(c)and(d),and 80-3,185,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 />