Laserfiche WebLink
X617 <br /> ��— 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 Name Type of Ownership <br /> ORPHAN GRAIN TRAIN ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 427 N SHADY BEND RD-GRAND ISLAND PO BOX 1565 HALL ❑Other(specify): <br /> City Slate Zip Code State Where Incorporated <br /> HASTINGS NE 68901 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> f / d CA Rte./fa-AP 'rroe ,�<ro 7dpcka, cif4; £rnr.4 �1G, .va b9 3c3 <br /> R• i4-14 er'C� '17 „ eck, .Y55nz.cecok� �tG. rNt 0Bels' <br /> vr�er��nr�( oN ftie4ver. W& & I&eat Slueo'rd> /Pe- <br /> reps-Surmar ��a b (y 5ax � 1ge.X /5'?, za tD/vE <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear BodyType _ - Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> KING OF THE ROAD 1985 MOTORHOME 2GBTG31MSE4162000 <br /> 118H 2015 TRAILER 5338C1211FC248693 <br /> GMC 2006 ' Ti2Un4' 1GDJ7C1376F901233 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exdusrvely <br /> ❑AgriculturavHorticultural ❑Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: ( YES ❑NO <br /> �dxC If No,give percentage of exempt use: <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 <br /> here ■Authorized Signature Title Date <br /> RECEIVED <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> � <br /> E 1PPR 0i ��aw® COMMENTS: A2 '"'d cS 7�T— O� <br /> ❑DISAPPROVAL lld�aasarr <br /> Pj rvi 2 O 2016 <br /> • Signature of Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION.USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND,NEBRASKAMENTS: <br /> ❑DISAPPROVAL <br /> 11 Authorized Signature Date <br /> Nebraska Department d Revenue Authorized by Nab.Rev.Stat.§§77.202(1)(c)and(d).and 60-3.185.and 60-3089 <br /> 95-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />