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DEC-04-15 02 :55 PM HABITAT FOR HUMANITY 913083855511 P. 01
<br /> e° Application for Exemption 1(�
<br /> � FORM
<br /> ■ • aaka b•. Ip,wntar Al . 1 U from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be filed with your°corny treasurer.
<br /> .Read matruelbne on reverse side •
<br /> Appfama Name Type of Ownership
<br /> GRAND ISLAND AREA HABITAT FOR HUMANITY ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 502 W SECOND ST PO BOX 1001 HALL 0 Other(apecity):
<br /> thy Slate - Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68802 NE
<br /> I . IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> 1 . Tae Nettie.Addnea,City,State,Zlp Code
<br /> 4)rrntrICI -r' eJk .0 Mark i "Ices 'zly O , Citric G-C- &BSc)
<br /> ve t'. e Al.., s eann t 40 V tt Lot m 4 k-.n,D /1 k 03
<br /> • .ri'at'�, (eel n .c - I3Gr'r I4i 1(ridLLkth,,1etz`'4f. 41157 G. 13$frty •
<br /> Trr.o(scx.re_r ALt.nie I +'�*k, 4157, Ani-e-Ino. byre—, lrr. H$'8o3
<br /> • DESCRIPTION OF THE MOTOR VEHICLES
<br /> i •Attach an additional sheet,If necessary.{ Rw1�Ar att
<br /> 4' ' Molar Whh*Make Mods.Year Bady Typo vehicle ID Number r Ellie of '
<br /> `_ - II Newly Pvrchssed
<br /> '
<br /> Rttnr(no&tr Lttir 2_[013 2wktet,°part
<br /> . C4.MG zpoW fICAKttip l-GTEC NC/ 8-7-101014
<br /> ' I:1S.C.DaCtiWhitkS OA V Parr 04rr.ttr 14RC'SI$2Zw ion Sta 3S
<br /> . rnI-r,.ltar4z lb00 ftanso+Cr:tyr t4x'd•tSE XZSY 4 o17R3t
<br /> •
<br /> 1t�H-4-racict ZOOS net* f r tl 4.1 G Ll r l $ 2i• 071$12. I •
<br /> btllmpt uus of Motor W hits: Are the matcflahiclee used exdushrely
<br /> ❑Agnwpunyhtoribuhural ❑Educational []Religious _Charitable ❑Cemetery a.indicated?
<br /> ••
<br /> : Ohm detailed descrblbn of use,lndudhg an explanation ii mope use classifications exist: lialiE 0 N •
<br /> •
<br /> ' lra,14r5 art. 1USCtt 'C 9 r Storare, of G e l t.- n-'...' - k f%a+dr,1)S as .-r11 AS
<br /> -�Ircn n S e r t of J It No,gNe percentage of exempt use;
<br /> P i-k«,-Is iccr hAb,�r.F.s wcrk-
<br /> %
<br /> a'"iee,c- tack. isQrt n4,-, )y{ v,scd 4,r Q (IC-ifs of ^.4ems and de Ii . nr.y,
<br /> plus ervcsArt.,Yto.1f' of ✓', Ills 4 d or,e.'}"I e „Is. `—ra .tF pt,}S
<br /> Si-A6f in p.trsu.T of oat.. net.5.5” on
<br /> • Under males of law.I declare that I nave examined PS appMatlon and that a is,laths heat of my knowledge and ballet,true,Gametal',and coned.I
<br /> also declare that I am duly authorized to sign ails exemption application,and that the organization Owning the ahova•Ileled property does not discriminate
<br /> In membemhp orampoyment based On rape,color,or national origin.
<br /> sign 1 ~u •/ti g , ZI y/V c
<br /> here I A Signature ri D
<br /> ' FOR COUNTY TREASURER RECOMMENDATION ``
<br /> •
<br /> 4'- .
<br /> �PROVA RECEIVED � . NTS: �-��y,�-�`-�
<br /> �eelaEgsG
<br /> ❑OISAPPR AL o0 OFFICyr In
<br /> �' 71
<br /> i�- �: J
<br /> DEC 4 2015 � � /Q—/-5- -�
<br /> ISignature of CountyTreasurer r ' Data
<br /> I HAI r (snn,.gy FOR CO NTY BOARD OF EQUALIZATION USE ONLY l
<br /> ! 'TREASURERS IAND NEBRAS
<br /> / 'APPROVAL •. . •ENTS:
<br /> o DISAPPROVAL „1 1 �L/�n/,(/
<br /> lVorI•. Signs dote
<br /> ',
<br /> fistaSt Detwlmemd Revenue Autocad by N .Rev.Slat g§Theotltx1)and NE end 60-3,teM,and eoi,tes
<br /> 9.433'2006 Rea 6-2OI I Sipeeedea 96.252-2000 Raw.'54009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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