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'eN�brr Departmen-i of Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> imitnnani •Read Instructions on reverse side. <br /> Applicants Name Type of Ownership <br /> GIRL SCOUTS SPIRIT OF NEBRASKA Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2121 S 44TH ST HALL ❑other(specify): <br /> City State Zip Code State Where Incorporated <br /> OMAHA NE 68105 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> CEO FRAN MARSHALL,2121 S 44TH ST,OMAHA,NE 68105 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> FORD VAN 1998 VAN _ 1 FBSS31 L4WHB00128 <br /> ENCLOSED TRAILER 2008 TRAILER 6'X 10' 1 DGCS10138M081611 <br /> ENCLOSED TRAILER 1999 TRAILER 4'X 6' 4X4TSE211 XN019853 <br /> FLAT BED TRAILER 1997 TRAILER 24' 44NFH1626VL021679 <br /> CHEVROLET 1992 PICKUP _ 1GCEK14Z8NE120850 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ®Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: NI YES ❑NO <br /> TRANSPORT GIRLS AND ADULTS TO EVENTS AND CAMPS. TRANSPORT <br /> If <br /> EQUIPMENT AND CAMPING EQUIPMENT, PURCHASING FOOD FOR GIRL SCOUT No,give percentage of exempt use: <br /> EVENTS. <br /> '� <br /> Under penalties of law,I deda$that I hake examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that l am duty authorized to si this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or employment based on r ,color,or national origin, <br /> i <br /> Sign ` CHIEF FINANCIAL OFFICER ' <br /> here - — Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> r. PPROVAL RECEIVEDOMMEf1T5: ,L- _piif7- <br /> tt <br /> -`.. yaf' �� �l _ <br /> -TaEgS <br /> ❑DISAPPROVAL c"?c, IC{�G 9m <br /> i <br /> NOV 2015 e! ,� ' L�". <br /> r„ <br /> Signature of County Treasurer Date <br /> HALL COUNTY FOR COUP TY BOARD OF EQUALIZATION USE ONLY <br /> 1 KtASUKtt(S OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> 'APPROVAL COMMENTS: <br /> ❑DISAPPROVAL , <br /> ''•or' S.natu . ate <br /> Nebraska Department of Revenue Authorized by Nell Rev.Slat.85 77-202(1)(c)and Idl,and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev 8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />