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itirt----z— Application for Exemption 9.)Di 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 /> GIRL SCOUTS SPIRIT OF NEBRASKA ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2400 E WILDWOOD RD HALL ❑Other(speedy): <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 /> Caere 02U h, htnc.r t�s- / fr .ti2� e o3 <br /> Cee./ Ft WI C4 v-s inc,k 1 re/52/ S 5/9"M ffm440 Ate 6,W0.5--- -2fiao <br /> ("cep Otac. r /Mark Wtrr — Cl )e <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> 0,27 Pick tala /99 ®rckter /SDo /CCT k Iyz7A4C/aegro <br /> flgf detl kra`tUr /9997 ..y / cQN ///6a.o ka,°P- Ib 77 <br /> ,tea 4 / y Var /FQS'sr3/ZV/WF/R at) /22 <br /> Ex mpt Uses of Motor chide:' �/' �� Are the motor vehicles used exclusively <br /> ❑Agricultural Horticultural XI Educalional ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> ��/jj'Give detailed description of use,including an explanation if multiple use classifications exist: J ,'YES LINO <br /> ,4o 'e 5/70t.J/ /lent/ t�'e 1f�bsr V'oo ch / /"Cef ti� I/NO,9 percentage exempt give ercenta a of exem t use: <br /> St OfPty5 UV*1+ j 1,, a-d 9,(41 19 arts, ff, od 50 (/ !rk % <br /> to even Ps- �- nit 6 ea✓-, <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 <br /> c�t�/ w� � ah�e✓ �`// /f/ <br /> here "_/ ignature Q Date <br /> rep COUNTY TREASURER RECOMMENDATION <br /> APPRO 'L RECEIVED COMMENTS: "� ' - ," Q 5 77-tae <br /> ❑DISAPPROVAL NOV 'i 3 2014 <br /> HALL COUNTY /Signature of County Treasurer Date <br /> TRCASURND OFFICE R COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND NESRASKt <br /> OAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL if <br /> /v/ � <br /> � sLai A/5 -9s <br /> A r <br /> oozed ig .tu : Date <br /> Nebreslw Department of Revenue Authorized by Neb.Rex.Stat.§g 77-202(1)(c)end(d),and 80-3,185,and 80-3,189 <br /> 96-2532008 Rex.8-2011 Supersedes 98.253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. , <br />