Laserfiche WebLink
Ll <br /> r V <br /> 4 ��— Z— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> Heartland United Way, Inc ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1441 N Webb Rd Hall ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> Grand Island NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> President,CEO Karen Rathke,3836 Meadowlark Cir,Grand Island,NE 68803 <br /> Board Charman Todd Price,1104 W Division St,Grand Island,NE 68801 <br /> Board Vice Chair Kelly Henry,3024 Bighorn PI,Grand Island,NE 68803 <br /> Board Treasurer Wade Jarvi,309 Buffalo Grass,Grand Island,NE 68803 <br />• <br />• <br /> DESCRIPTION OF THE 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 Nev"•o..•"heced <br /> Haulmark 2014 Trailer 575PB1420EH264757 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturatHorticultural ❑Educational ❑Religious ®Charitable 111 Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: el YES 0 N <br /> The trailer will be used for United Way programs, fundraisers and events. Several programs <br /> involve hauling toys, food and household furniture. The trailer will be used for hauling If No,give percentage of exempt use: <br /> program items to community partners located in Hall, Hamilton, Howard and Merrick <br /> Counties. The trailer will also be used by staff to travel to United Way functions that require <br /> hauling event items locally, statewide and out of state. <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 membershi• •r employme_-sed on race,color,or national origin. <br /> sign �•%j t I fith President&Chief Executive Officer 09-01-2016 <br /> L..L�11n.u.� <br /> here Authorized gnature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION RECOMMEENDAAT IION <br /> .el /r• d"- �]� .5..5; Qo2 <br /> PPROVAL RECEIVEIrMME,TS: <br /> ❑DISAPPROVAL <br /> S E p 2 016 ,Caf/Q <br /> Signature of County Treasurer Date <br /> ux . ^gyppyFOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL. wiVmMtn.I S: <br /> ❑DISAPPROVAL e A <br /> Au •�3-d ign. Ii f7. ' '' / r Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d).and 60-3.155.and 60-3.t89 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />