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�rl--� Application for Exemption �, 0/ Li i 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 /> PROPERTY ASSESSMENT •Read Instructions on reverse side.
<br /> Applicant's Name Type of Ownership
<br /> GRAND ISLAND DIVE AND RESCUE TEAM ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 3107 WOODRIDGE BLVD HALL
<br /> Other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68801 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br /> I Title rN�ame,Address,City,State,Zip Code �
<br /> Pee /2.5r. .r Jvs]vL- LEriatee6,,//73 E,Ur7 e4c_,e/a /Zinc) C'A-'/T,.JA
<br /> Z1.4 j E I/( E PC I
<br /> / F flat.5i�FN7— /47 EzypLEws�i, 5G 6/SI ci' 62.414-"A /s a,U e./i
<br /> EjC' t
<br /> „t ki,CrAi2/ _.t ,°pc Li/etC,!1 4i/(c I</ .g1QC-c=V Aver 4ee av /ic..r,r/:),X/it 6n0-23
<br /> rte "isu,ec-T 297- /o.0 w.a dj h09 liAtobrz>lr- /3/fA) ,4.,Lb 444,/,,, J/ • GFPFkI
<br /> DESCRIPTION OFTHE 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 /> ZL (24":360 3244086023 Z/T/z.1T'/ %12 c /1,/Czet-C7 ,17/0'no? Pc. &d7
<br /> Zco3 /-Z5-6ESic 39 /9
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> 0 AgriculturalMorticultural ❑Educational ❑Religious ®Charitable 0 Cemetery as indicated?
<br /> Give detailed description of use,including an explanation it multiple use classifications exist: ,?YES 0 N
<br /> n/5 /r'4/LL"!:f /5 L cD i>_) / '.4.iSf c e r fJ/t/E T-c 5EL'F 54%/_i/f'/ i1J-f- `7
<br /> &JRWL , R6 51-7//76/-7/A-/ eR,44., k.:4,0 ,z/6-- te, ea, / Lc/rlic/c Ak---eAre-Jb fNo.gve percentage of exempt use:
<br /> F/c ,06—, // '=(4eiv / /L. />'/=C}1 4. _ %
<br /> 1 TLj>
<br /> ✓SCDF fte a/r -A' SRF'E71 //2Avc/%uh <1- 555 4L.56 /.c, teilzii�
<br /> "5- ,q ib NC Nu/s crtitc,- «S6:7 Tv • .4.1
<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 membentip oremployment based:on race,cobr,or national origin.
<br /> /sign
<br /> _
<br /> _ /eE �Sr✓eE it
<br /> i �S
<br /> here I!'A u`ori7 z g1 to ( /// ,— ----- Title Date
<br /> FOR COUNTY TREASURER RECOMMENDATION S
<br /> Ea-APPROVAL RECEIVED CORMENTS: -:-- /�s' "- 4/ , -4 - W 77 `'
<br /> 1
<br /> .t.1RFgy,
<br /> I ❑DISAPPROVAL ol'e'. wt., Gqm
<br /> NOV 1 0 2015 0�� ;,,SEAL
<br /> i►Signature of County Treasurer - Date
<br /> Asi iRFRs of FOR C)UNTY BOARD OF EQUALIZATION USE ONLY I
<br /> ?REAR!IRFRS OFFICE
<br /> GRAND ISLAND,NEBRASKA
<br /> [APPROVAL COMMENTS:
<br /> 0 DISAPPROVAL 02///
<br /> Authorized Sig velure Dale'
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),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.
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