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A 1 <br /> Iret--e— 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 /> GRAND ISLAND AREA HABITAT FOR HUMANITY ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 502 W SECOND ST PO BOX 1001 HALL ❑Other(specify): <br /> City State Zip Code Slate 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 /> Pres'der+ JcrannyyWeimerseIbl3 E Phoenix Ga- we_ b$goI <br /> V, P. t)tLL(e hl v cka 2140 IQ...Tackr aI NE 44803 <br /> TrPtx5Vre{ trams ssein-gdnyZII Ponderesa.br. al NF i,8ro3 <br /> $ctrC i to JGnniktr bernT� 1104 t..aKerl uve.;r i Ise A-i WE ago 3 <br /> J DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Bodylype Vehicle ID Number Date of Acquisition, <br /> It Newly Purchased <br /> Hotncmad a 4-rn,1e.r 2t i 3 Z wkgel y open <br /> atekC Zoo 81 rnck•tn.p 1GTEC.I4C9$Z9ott14- <br /> IdSCeo,thovorks IAA S' Cy.0 +rn_�3er 4.y�C.51 $2Zw7ooS23S <br /> Ccohnen'l-aj Oar e3 o loco O 0 +rni.Icr 4x44TSE$ZSY401.?039 <br /> 4*- 14 -Frcuier 2coC, Fin. Bra 4 16,LLF1.821058 b-718tp,1 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturalMorticultural 111 Educational 111 Religious 5it Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> r Trai lers are ascot Per Stor c 4� enyts'tructt o/• ��`p merit an 4 Su.pp Iles. If NO,give percentage of exempt use: <br /> 'They an on Ste road +o sport- l-ta.I;;+ar lien's�m st'k 4o s;-le . p <br /> r That-ructc. is i.tsec pr.mar. l f � by the Re.Stcye. 'COY Fit ck �'P Cr c� clOn 2ln`onnr <br /> proCw-errte,wt o.c don:AA-ions 0 transport o4 i3/4.1;i440- ,naiu-t'a-LS an4 <br /> �{ personnel (an 441V r+nt business. <br /> All are tlsed+D &r Na6' 6.4's tin'I5Stan i tow-Income- koccs,n5 .pro9rtITS <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 not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign r ea _ . g. D • "/3//9- <br /> here Authorized Signature T e Date no_ <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> P GY <br /> PROVAL G .AENTS: / ar �• _ ��_ O-2, <br /> ❑DISAPPROVAL RECEIVED .._._2 <br /> 0 E C 3 2014 I Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> OFFICE <br /> [lAPPROZL GRARND isLANDS <br /> , NEBRAsKACOMv1ENTS: <br /> ❑DISAPPROVAL <br /> / <br /> /� i <br /> .L/ r <br /> A.. .r ' /-1-3 - 5 <br /> nr■od.=. ig 'tore Date <br /> Nebraska Department of Revenue Authorted by Nee.Rev.Stat.§§]]-202(1)(e)and(4 and 603,185,and 605,169 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />