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d � <br /> A\ <br /> at.-LZ 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 /> Applicant's Name Type of Ownership <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA INC ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1804 S EDDY ST PO BOX 1863 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide Name,Address,City,State,Zip Code <br /> Per PA-Al-Ached <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 /> \er P.k-ka ei* . <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural cg Educational 111 Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed ascription of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> 1.d '9,�tn3.�� ar.d �,.n C22' t vs . <br /> If No,give percentage of exempt use: <br /> A\so, t& ea - 5 p-po o. Glte c s 1\cX u t V .es <br /> ctnd -�{ate„.-,- , ,\ • 5a---- 0-4--c-1,..s.ed s.e" Avsv.,._ <br /> eon*M� 'fir? ea'. ck rb Ciceck 308-3 "18rt�x lyt <br /> Under penalties of law,I declare that I have examined this application and that iI is,to the best of my knowledge and belief,true,complete,and correct.l <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 3� Q�i dry /1-/,�I <br /> here I,AUthonzed Signature Tale Date <br /> L FOR COUNTY TRE�ASSUURRER RECOMMENNDDAATTIIO/N <br /> PROVAL RECEIVEDMMENT3: �° /— ,� � sots <br /> ❑DISAPPROVA. <br /> Nov 1 7 2014 6 y eX i 8—/. __-•• <br /> It Signature of County Treasurer Date <br /> HALL COUNTVOR COUNT'BOARD OF EQUALIZATION USE ONLY <br /> ^E _-_ rrC <br /> GRAND ISLAND,NEBRASKA <br /> .APPROVAL COMMENTS: <br /> ❑DISAPPROVAL /j <br /> �L. rued ! .j s;. ate 315 <br /> thorized =ure ' Dale <br />• <br /> Nebrasla Department of Revenue Authoreed by Neb.Rev.Slat.§§77-202(1)(c)and(d),and 03-3,185,and 803,189 <br /> 96-253-2036 Rev.82011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />