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• 0 /7 <br /> Ne^�— Application for Exemption FORM <br /> braska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> Ellniil III <br /> •TO be Hied with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> HALL COUNTY LIVESTOCK IMPROVEMENT ASSOCIATION FONNER PARK ®Nonprofit <br /> Street or Other Mating Address County Corporation <br /> 700 E STOLLEY PARK RD PO BOX 490 HALL ❑Other(specify): <br /> City State Zip Code State Where incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title PRESIDENT a buns ""-° Q '-en MONTE HEHNKE 4019 NORSEMEN AVE GI NE 68803 <br /> 1ST VICE GREG BAXTER 2121 N MONITOR RD GI NE 68803 <br /> 2ND VICE STEVE HANSEN 1420 STAGECOACH RD GT NF. 611801 <br /> 3RD VICE MIKE JAKITROWSKT 3510 S VATNF GT NF 6RR03 <br /> SECRETARY ' DAN FOGLAND 4604 LAKESIDE DR GI NE 68801 <br /> TREASURER RUSS RERUCHA 2024.`STAGECOACH RD GI NE 68801 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> • Motor Vehicle Make ModelVear Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> SEE ATTACHED LIST <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ®Agricultural/Horticultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist ®YES ❑NO <br /> 4-H ACTIVITIES, COMMUNITY ACTIVITIES, PROMOTIONAL EVENTS OF AN <br /> • EDUCATIONAL OR CHARITABLE NATURE, HORSE RACING, AGRICULTURAL EVENT N give percentage of exempt use: <br /> INCLUDING THE HALL CO FAIR & NE STATE FAIR & STATE 4-H HORSE SHOW % <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 membership or employment based on race,color,or national origin. <br /> sign _ __ ut [ i CEO . 12/01/16 here Authorized Signet � UCE SWIHART <br /> Tale Date <br /> i FOR COUNTY TREASURER <br /> AP _ RECOMMENDATION <br /> - <br /> 77 7C-Ye "tit- "1-, c.$. �- <br /> _CPROVAL <br /> RECEIVED <br /> ❑DISAPPROVA ! f��yq1 �J <br /> DEC 2 2 10 •Signature W Obunty Treasurer , !.''./-r , <br /> Date <br /> FOR COUN BOARD OF EQUALIZATION USE ONLY J <br /> HALL COUNTY <br /> TREASURERS OFPlCE_ <br /> ❑APPROVAL GRAND ISLAND NE ME S: <br /> ❑DISAPPROVAL <br /> AO <br /> thorized •nature V Date <br /> •Nebraska Department of Revenue Authorized by Na b Nev.Stab§§77-202(1)(c)and(d),end 60-3.195.and 60.3.159 <br /> 96-253-2008 Rev.5-2011 Supersedes 96-2512006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />