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e..--1.---,_ Application for Exemption FOR! 7 <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 /> THE SALVATION ARMY ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 818 W 3RD ST HALL ❑other(specify): <br /> City State. . _ , Zip Cote _. 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 /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehlolo.ID Number Date of Acquisition, <br /> If Newly Purchased _ <br /> FORD 2015 TRANSIT VAN 1FBZx2ZM7FKA91712 <br /> .-- Z_ • 1GNKRGKO5GJ272028 <br /> asap wow- 5r14Rl. a�F426.SL311a <br /> I <br /> Exempt Uses of Motor Vehicle: h <br /> ,�, ^` Are e motor vehicles used exclusively <br /> ❑AgriculturalHorticultural ❑Educational [j'Retgbus charitable ❑Cemetery as indicated? <br /> Give data iced descdptbay(sae�tpgi Iv nation n Nthiple use classifications exist ❑YES LINO <br /> K 1lre/V'LFs 1`■/� If No,give percentage of exempt use: <br /> NOV 1 4 2016 <br /> HALL COO <br /> TREASURERS <br /> vi•IMRIC... <br /> `'• <br /> >a - mined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare its am du Pa I •died to sign this exemption application,and that the organization owning the above-listed properly does not discriminate <br /> in membershi• •rem• •. .nl based on race,color,or national origin. <br /> sign <br /> here M���r p ate fib <br /> Authorizes+ig - A_ Title3O$/390 " L/y o Date <br /> I FOR COUNTY TREASURER RECOMMENDATION <br /> HrPROVAL COMMENTS: % �� 45:4=5, 77 <br /> ❑DISAPPROVAL <br /> f <br /> Signatu of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorize.]by Neb.Rev.Slat§§77-202f IMO and(0),and 60-3,185,and 60-3189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.52009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />