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?b1S <br /> .....n.,- 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 /> GIRL-SCOUTS SPIRIT OF NEBRASKA 2:1 No. .. <br /> nprofit <br /> Street or Other Mailing Address County Corporation <br /> 2400 E WILDWOOD RD HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 - Nt <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code r <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 /> '%"c/" '1 frc &✓ .Gok 6Y/o fro:r: /06 Cs/U/flmc)J'/6// <br /> �nr/<ty/ T/ Mt /y97 yy (c 1rAALr 4/,Yr/ Tfn�//ry A/o/9JS°1r <br /> ///one /0,4 -Trc ✓ /9�� CG c e_ A/U/f eC�?Get c. <br /> • /TGG4 -f / QB <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> Ill Agricultural/Horticultural "Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: //''�� IXI 'ES ❑NO <br /> /+04 / Celt ' + G eat/, SO"fir5- Chi. ho es/ L.CSOk%6 II No,give percentage of exempt use: <br /> fD O}-ter `J-x Mnc, <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 /> i <br /> sign i a �,,Ml,p 0241 eZ //-//- 20/y <br /> Uhere nzed ignature True Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> PAPPROVAL RECEIVEDOMMENTS: e,a_z..e.) ' '4 4• X77 ®' <br /> ❑DISAPPROVAL <br /> NOV 1 3 2014 X -12-1 /..-.1"'`7'5-- <br /> /Signature of County Treasurer Date . <br /> HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> (II APPROVAL BENTS: el j❑`DISAPPROVAL � e./la / <br /> r <br /> / /3 /C <br /> 11/111.Authorized Signature Date <br /> Nebraska Department at Revenue A thorbed by Net Rev.Slat.§§77-202(1)(x)and(d).and 60-3.185,and 603,159 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253.2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />