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gO/7 <br /> - Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> GRAND ISLAND DIVE AND RESCUE TEAM Z Nonprofit <br /> Street or Other Melling Address County Corporation <br /> 3107 WOODRIDGE BLVD HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> P• es;a,e7T 0nwEn l e-.v g to //Z3 Fst . :zi dczkia 1 d' -v 3O <br /> i <br /> . A. .., $i . _ e A . a _ • 04 4, , <br /> . •i ,f a . 4 ; • - 4,4 d f. -. a te - <br /> _ .. 1 <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 I Vehicle ID Number Dale of Acquisition, <br /> If Newly Purchased _ <br /> WEE CARGO 2003 UTILITY TRAILER 1WC200F2831103907 <br /> s _ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ❑Ries $Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation If multiple use da. ifipatfons exist: ki YES ❑NO <br /> /tip pZAiL.c:k' i v i ,z iP{v#SPoef O/vC P'EYCisc cQOsf',in5,,As0 <br /> /-lev,J7 i& R.M. Fiat 5,-wo:.i /.ri G r24ub /Sr„9t{6 Al /J a No,give percentage of exempt use: <br /> 9Y wig <br /> CCJ o.°r % <br /> k�E,C✓�-TG's R :SCE4E 44 mob A,P-Ctfv/7 areti4k'/.i /SA✓!S A/E <br /> MAK 4L$o 4'e cife,D r=ow. k/,4,fl ;Are7 i 1/24ius..ib a,,csES <br /> 4 r.SO Ate/ &4Si/s I SC. 'Jp Ai- nob on/cQ Guoge ra4/fns <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 duty authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> In membership or emproyment on race,color,or national origin. <br /> sign / T,zansysC f/ es 1C� <br /> here ,ANhorized Title Date <br /> FOR COUNTYTRREEAASU�RER RECOMMENDATION <br /> kPPROVAL RECEIVED COMMENTS: , 2-4-4-' .M45iS' A77-Gc' <br /> ❑DISAPPROVAL <br /> NOV 2 8 2016 `�a� N v /.2 -. / . <br /> Signal of my Treasurer Date <br /> I uar r rrn FOR CC UNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFF <br /> GRAND ISLAND,NEBRASKA <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> /—,10—/f <br /> • •rize• ignatu =r Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.%77-2020)(c)and(d),and 60-3,185,and 603,189 <br /> 98-253-2006 Rev.8-2011 Supersedes 96-253-2006 RN.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />