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ao/rl of Nebraska Department- Application for Exemption FORM REVEN E from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 •To be filed with your county treasurer. •Read Instructions on reverse side. Applicant's Name - I Type of Ownership GIRL SCOUTS SPIRIT OF NEBRASKA ®Nonprofit Street or Other Mailing Address County Corporation 2121 S 44TH STREET HALL ❑other(specify): City State Zip Code State Where Incorporated OMAHA NE 68105 NE IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION Title Name,Address.City,State,Zip Code CEO FRAN MARSHALL,2121 S 44TH STREET,OMAHA,NE 68105 I DESCRIPTION OF THE MOTOR VEHICLES •Attach an additional sheet,it necessary. Registration Data or Motor Vehicle Make Medal Year Sady type Vehicle ID Number I Date of Acrrydakion, if Newly Purchased FORD VAN 1998 VAN _ 1FBS831L4WH600128 ENCLOSED TRAILER 2008 i TRAILER 6'X 10' 1 DGCS10138M081611 ENCLOSED TRAILER 1999 TRAILER 4'X 6' 4X4TSE211XN019853 FLAT BED TRAILER 1997 TRAILER 24' 44NFH1626VL021679 CHEVROLET 1992 PICKUP 10CEK14Z8NE120850 Exempt Uses of Motor Vehicle: I Are the motor vehicles used exclusively ❑AgricutturaVHorticultural Educational Religious ❑Cemetery as indicated? ❑ ®GhardaNe Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO TRANSPORT GIRLS AND ADULTS TO EVENTS AND CAMPS.TRANSPORT EQUIPMENT If No,give percentage of exempt use: � AND CAMPING EQUIPMENT, PURCHASING FOOD FOR GIRL SCOUT EVENTS. Under penalties of law,I declare =t I hsS examined this appkplpn and that it R,to the best of my knowledge and Oeliel,true,complete,and correct.I also declare that I am duly aut . ized to sign this--.y.plion application,and that the organization owning the abovedleted property does not discriminate in rshlp or employmen based on ra e,color, r national origin. I . sign , iv to i CCAC 1o!31l M O here IAuthor' Ignature 1 Title Date f ,,_, Ip.[/q @g..){ p*FOOR'�COUNT Y TREASURER RE�CO7MMENDATION i Itl"at'PROVAL RECEIVEL/ MENT° t-f" AOy. y`5 — 7 - e? ❑DISAPPROVAL NOV 4 2016 ;°�°` A:37- i� Signature of unty Treasurer Date I • . • , a.R COUNTY t OARD OF EOUAUZATION USE ONLY J TREASURERS OFFICE GRAND ISLAND,NEBRASKA . ❑APPROVAL VOTT 1 . ❑DISAPPROVAL An��®� /� ate' %0.Mrs mss— r!/_!t 21��/! _' lzed Signature r Date Nebraska Department M Reenue Authorized by Ned Rev.Stat.§§77-202(tl(c)and(d),and 603,165,and,03,169 9e-253-2006 Rev.8-2011 Supersedes 06-25,-2006 Rev.5-2009 PLEASE RETAIN A COPY FOR YOUR RECORDS.