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,Evn_---e_-e__ Application for Exemption ✓1 J f FORM
<br /> Nebraska Department of t/�,-
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations r
<br /> •To be filed with your county treasurer. 457
<br /> •Read instructions on reverse side.
<br /> Applicant's Name Type of Ownership
<br /> HOPE HARBOR INC
<br /> ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 610 W DIVISION ST PO BOX 1544 HALL Dottier(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68802 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code �, _ ,1
<br /> f eei rU f'1 i-N--t✓an"i a ./ h-,;,,, 5�]'iO KrYY'.tu 3C � Clronlj �fttrf_`I , 1v1,�,� LflO/
<br /> 7rta5 trfC L tin n fl,-t i,ien a?22 3 Lukti2Atek br i&srArrt 151anOL illf, c)-7.70 i
<br /> V.ci Pt k,.(*Qin+/9 Cr( kf`<A / t &i r 'rrne/r 51)(6 e) C0lrhorre_l PA ( rrlYii Sb-)(0r0/16e (in', f
<br /> ,3
<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 /> ChaYrnie+ (ip/ander a00i,, /y7;-,'vim Entt V31-0(ohi(a 9y. /-5/ 5-
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> 0 AgriculturallHorticultural 0 Educational ❑ Religious Charitable 0 Cemetery as indicated?.1141
<br /> Give detailed description of use,including an explanation If multiple use classifications exist: YES ONO
<br /> tfle-iiC It. 5 ,,eicc- bs-rhe. hor- ie.55 5be-I-ter : cxrortri
<br /> _x If No,give percentage of exempt use
<br /> 1 ' `�-
<br /> Sh-01)�; / P Elute Up r:�i, 00S/ --h�in/spr it
<br /> Apr rr-hnerrf5 (1i'u� -In , +7(z
<br /> 511-07CP -fa 4-0;ti'r tq5 .
<br /> Under penalties of law,I declass/hat I have examined this application and that it is,to the best of my knowledge and belief,(me.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 /> sign ,�
<br /> 9 n I�0vv EXe(ickJP fi iredor -X- (;
<br /> here I Authorized Signature Title date
<br /> FOR COUNTY TREASURER RECOMMENDATION ^� 2-
<br /> ©APPROVAL RECEIVED COMP,/ENTS �-11,--G `- /7«, ,4 .. �' 7� �6 °
<br /> 6. e f ,
<br /> 'a
<br /> ❑DISAPPROVL i' i- f.>
<br /> �p r� I SEAL
<br /> hi V °[ � ¢arc-'W / -/.1"-/
<br /> ,Signature of County Treasurer Date
<br /> I HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> THtASUHtK5 Oh Hut
<br /> GRAND ISLAND,NEBRASKA
<br /> APPROVAL COMMENTS:
<br /> ❑ DISAPPROVAL
<br /> ials ;�_-1(414,AN 'zed Si at Date
<br /> Nebraska Departmerd of Revenue Authorized by Net Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189
<br /> 96-253-2036 Rev.B-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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