Laserfiche WebLink
N,br,,,+s Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be sled with your county treasurer. 457 <br /> •Read instructions on reverse side. <br /> Applicants Name <br /> Type of Ownership <br /> Mosaic <br /> Street or Other Mailing Address ®Nonprofit r rats <br /> 9 County Corporation <br /> 2846 Old Fair Rd. Hall <br /> ❑Other(specify): <br /> CM State Zip Code Slate Where Incorporated <br /> Grand Island NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> See attached <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 /> it Newly Purchased <br /> Chevrolet 2015 Sedan 1G11C5SL7FF202221 01/07/2015 <br /> Chevrolet 2015 Sedan 1 G11 C5SL8FF206830 01/07/2015 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agriculture/Horticultural ❑Educational ill Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist El YES 0 NO <br /> Transportation of disabled individuals <br /> If No,give percentage of exempt use: <br /> % 9 <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 /> • <br /> sign Business Manager 01/07/2015 <br /> here Authorzed Signatures Tele Date <br /> I FOR COUNTY TREASURER <br /> R RECOMMENDATION Af C <br /> APPROVAL RECEIVE-DAMENTS �/r"' — / '`5 5- 77--gpaz • <br /> • <br /> ❑DISAPPROVAL <br /> JAN 9 2015 G —eypr o62t4& t /- 9-i5r <br /> Signature of County Treasurer Date <br /> HALL COUNIROR COUNTY 30ARD OF EQUALIZATION USE ONLY <br /> I KtMOV KtKb UM+TCE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL a i <br /> ���'l% 1 /J.lit , -gib s <br /> Au! +'z,• ignatu • — Date <br /> Nebraska DeprNmm of Revenue Authorized by Neb.Rev Slat§§77-202(11(c)and(d),and 603,185.and 60-3,169 <br /> 96-253-2006 Rev 8-2011 Supersedes 96-253-2006 Rev 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> • <br />