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+i^-z- Application for Exemption .2) l (g FORM
<br /> Nebraska Department of
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations
<br /> •To be filed with your county treasurer. 457
<br /> •Read instructions on reverse side.
<br /> Applicant's Name Type of Ownership
<br /> CRISIS CENTER INC
<br /> ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 2251 N WEBB RD PO BOX 5885 HALL
<br /> ❑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 /> Title Name,Address,City,State,Zip Code
<br /> i I i f ri17, i 1- , ,WW11'�t, , I, I► , ri 4 i
<br /> PAI IIMIZI L _ ,•u , _, 1 ors Tom- i < (fir,
<br /> s ►.,.�,.il'�cT a . r r ► * at N .h11M12 ivR: _ , INS .,,.,
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> Motor Vehicle Make I Model Year Registration Date or
<br /> Body Type Vehicle ID Number Date of Acquisition,
<br /> If Newly Purchased
<br /> C,heWrolek a\001 Ven+urtVan LaNDX030110�099
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑AgriculturaiHorticultural El Educational El car Religious p0_Charitable II]Cemetery as indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: r� 'RiYES ❑NO
<br /> V (d e, I S` used co r CA I p f.-l+tro s po rtta4-i Q n 1 setts i^ I y3 If�No,lgive percentage of exempt use:
<br /> Pletee , V$\ -bore) in over fo"u1+frleath Co 41+Ies) otona-I�iions), I ' '
<br /> ox,d preseni-a+lonS -fravc1 .
<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 /> 30S— 388—(�950 le
<br /> sign (32_,,,,, . u ,t, • _'A i ecx jj. )iree` r tl4 M�y
<br /> here Authorized Signature Title Date
<br /> 1p�. �pv'.•
<br /> CI FOR COUNTY TREASURER RECOMMENDATION
<br /> [APPROVAL RECEIVEfMMENrS /zu-. », .s.:. / te.c .4 %%', /-C.t1_..
<br /> �`.(Tp�SL
<br /> ❑DISAPPROVAL 9
<br /> c
<br /> NOV i ',Lr 2015 `��2, << �e/ .,l
<br /> �bflM'Ip z "l_-s f-J�
<br /> I Signature of County Treasurer Date
<br /> I___..— HALL COUNTFOR COUNTY BOARD OF EQUALIZATION USE ONLY j
<br /> TREASURERS OFFIOE
<br /> GRAND ISLAND,NEBRASKA
<br /> APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<br /> a , a_
<br /> A prized S matt rate
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d).and 60-3,185,and 60-3,169
<br /> 96-253-2006 Rev.8-20f t Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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