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12/10/2015 11:19 3083822494 AMERICAN RED CROSS PAGE 01/01 <br /> Iiii Application for Exemption FORM <br /> NnnrnekooCaD�an(m`rn of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> Gr •To be Bled with your county treasurer. J <br /> •Read Inatrucdona on reverse side. Type of Ownership <br /> Applloent's Nema <br /> AMERICAN RED CROSS II Nonprofit <br /> County Corporation <br /> Street or Other <br /> THIRD STREET HALT_ <br /> 404 E THIRD STREET CI other(specify): <br /> State Zip Code State Whore Incorporated <br /> City <br /> GRAND ISLAND NE 6B801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Narita,Address,City,State,tip Code <br /> CHAIR REGINALD RHOADS 1503 Branding Iron Lane Grand Island,NE 68803 <br /> VICE CHAIR JR ROTHER 4148 Norsman Ave Grand Island,NE,88803 <br /> SECRETARY BRAD BELL 1118 E 7th St Hastings,NE 68901 <br /> MEMBER KEN BRUCE 1523 W John St Grand Island,NE 68801 <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary, <br /> Registration Date or <br /> Motor vehicle Make Model Veer 'Body TWA Vehicle ID Number Date f Newly Purchased <br /> DODGE 2000 GRAND CARAVAN 1B4GT44LXY8571994 <br /> DODGE 2013 GRAND CARAVAN 204RDGBG4DR771457 -•- <br /> FORD 2009 E•450 IFDXE45P19DA80312 <br /> Are the motor vehidee used exclusively <br /> Exempt Uses of Motor Vehicle: as Indicated? <br /> 0 AgrlcvtturaMHordcuhural ©Educationet ❑Rellybu4 ®Charitable 0 cemelory . <br /> Give detailed description of use,Including an explanation M multiple Use dassMcationa exist•. YES . ONO <br /> m.0-$4•. vehlcaa ant. us*l Tar hpy'^anit''Ylan cols, Such If No,give pe centaga of exempt use: <br /> (.i5 dlsctsler Ye ion s r$C01/PXtx yep f <br /> 'BIN a Y2 iss to( jht Ni Iss IDh of the A-MCrt car Red Llzoss • <br /> �iY,�er+can a ISS ,revc_rtis and A lie V1ot4e5 hunvulr� <br /> -The UGC CtvTUgt^��s by Maui It�tn.�' 11tc I:xyt.rer� <br /> .51Cert to1ht donoR.s , <br /> ,lll� t d _pa ��eb rethaerazi}7 of <br /> Under penalties of law,l do re Poet I have examW due appllCetlOn and that x ts,to lire beat of my knowledge and beeef,hue,complete,and eorroct I <br /> oleo declare that 1 am duly authorized to sign this exemption application,and that the organization owning the above-Hided p2ronperty dime not disalrnlnate <br /> in me • : IP or employment based on taco,color,or national engin. SO$-B q$-1(a 40 <br /> sign i A, I i �� A EXECUTIVE DIRECTOR 12/04/2015 <br /> here Authorized Signature 4 Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION J <br /> Q APPROV4L RECEIVED COMMENTS: �w c4) .--it..-7 fi=r � <br /> ❑DISAPPROVAL la <br /> DEC 1 0 ?`!95 <br /> RAJ I nni awry <br /> signature of County Treasurer Date <br /> TREASURERS OFFICE FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> rr <br /> - lAND 1.3LAND;TV[E7t�trcA <br /> JPPROVAL COMMENTS: <br /> O DISAPPROVAL <br /> Idrigair A//Of 6 <br /> Au IYed !, D <br /> weeks ibprlmmi of Re.noIm A,ahorbi d by Net ROY.aaa.§}47-202(1)(c)end(d).and 663,168 and 904,169 <br /> 98.263.2008 Revs a-pa14 supersede°913•2662D00 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />