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Ska Dep Application for Exemption 9 6 Up FORM ha/MI.1E from Motor Vehicle Taxes by Qualifying Nonprofit Organizations •To be filed with your county treasurer. • 457 •Read instructions on reverse side. Applicant's Name Type of Ownership HALL COUNTY LIVESTOCK IMPROVEMENT ASSOCIATION FONNER PARK ®Nonprofit Street or Other Mailing Address County Corporation 700 E STOLLEY PARK RD PO BOX 490 HALL []Other(specify): City State Zip Code State Where Incorporated GRAND ISLAND NE 68802 NE IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION Tltle president Nan Adareee Gty, -GDae STEVE DOWDING PO BOX 5315 GI NE 68802 1ST VICE: MONTE HEHNKE 4019 NORSEMEN AVE GI NE 68803 _ 2ND VICE: GREG BAXTER 2121 N MONITOR _2D GI NE 68803 3RD VICE: STEVE HANSEN 1420 STAGECOACH RD GI NE 68803 SECRETARY: MIKE .TAKUBCWSKI 3510 S BLAINE GI NE 68801 TREASURER: DAN FOGLAND 4604 LAKESIDE DR GI NE 68893 DESCRIPTION OF THE MOTOR VEHICLES •Attach an additional sheet,if necessary. Registration Date or Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, if Newly Purchased _ SEE ATTACHED LIST Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively ® AgriculturaVHonicultural ❑Educational ❑Religious Charitable ❑Cemetery as indicated? Give detailed desctlptlon of use,Including an explanation it multiple use classifications exist: f]YES ONO 4-H ACTIVITIES, COMMUNITY ACTIVITIES, PROMOTIONAL EVENTS OF AN EDUCATIONAL OR CHARITABLE NATURE, HORSE RACING, AGRICULTURAL EVENTS If No.give percentage of exempt use: INCLUDING THE HALL CO FAIR & NE STATE FAIR & STATE 4-H HORSE SHOW % 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 also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate in membership or employment based on race,color,or national origin. sign .._.____ g.i`J u--c- � e C 1 CEO 11/9/15 here Authorized Signature,_BICUGB SW 1HA P T81e Date FOR COUNTY TREASURER RECOMMENDATION i- APPROVAL RECEIVED CO MENTS: A-'-ip-'../3t Alp-i' R/rJS,-";' ! 77 - 91 ❑DISAPPROVAL °°°ecicy� NOV 2015 s SEALd HALL COUNTY il Signature of County Treasurer Date TREASURERS O rte R •e UNTY BOARD OF EQUALIZATION USE ONLY „ McANn fSLANA,AtFlaieneos 'APPROVAL COMMENTS: ❑ DISAPPROVAL Ii I/Are,t rikei �� - 42V.26/t Au crized Sig,:ture r Dote Nebraska Department of Revenue Authorized by Neb.Rev.Stet§§77-202(11(c)and(d),and 603.185,and 60-3,189 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 PLEASE RETAIN A COPY FOR YOUR RECORDS.