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me^..----z— 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 United Veterans Club Honor Guard Type of Ownership <br /> 1 Nonprofit <br /> Street or Other Mainl 4 Wiltst Capital Avenue Hall Corporation <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> Grand Island Nebraska 6RR0'1 NPhrastra <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,Slate,Zip Code <br /> Chairman Mike Ponte_ 216 E 18th St Grand Island NE 6RRO1 <br /> Treasureii Verne Hill 3228 W 18th St Grand Taland NE 62803 <br /> Director Richard Simpson 426 S Woodland Dr Grand -island , NE 68801 <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 Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Ford Fronoline F3590 2014 , Van_ 1FBSS3BT,3EI1A71354 , 1 /11 /9017 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> El Agricultural/Horticultural El Educational ID Religious ®Charitable KI Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: OYES LINO <br /> Used to transport Honor Guard members to perform <br /> military rites at funerals for deceased veterans . It No,givRfjp0e: <br /> A•13\rM�iJ{-i-t.,-ref 1cbi r�"p1 aS v'Qr y l v t-. )1v'h�f Cso s'•� I+l¢ Co-S jy i. <br /> I. Q. ,'l«)-1y.y1 t�<Y� S \I Ii�� is' <br /> JAN 232017 <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge an I belief,true,,14 .4rG �L <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the aboverlisted prolZeRy,dgBS oo'i'dS ,,_J7,7KA <br /> in membership or employment based on race,color,or national origin.sign . ' 7.21 / 7 <br /> here Author' Signature t Tide Date <br /> r.,� FOR COUNTY TREASURER RECOMMENDATION -1 <br /> ®'lCPPROVAL COMMENTS: .G �y Ai.-CS A77—°�c°l <br /> ❑DISAPPROVAL �p/� �y, <br /> k' c) C /= 23—/7 <br /> Signature of aunty Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL r� <br /> s� /L I/i-iii%/.. ',/ J r .02-7-77 <br /> -77 <br /> horized ignature lir Date <br />-Nel...AAu Csycnmen,ut nown.e Aulbbnzed by Nett Hey.Stat. 11-20211)(cJan ,a s,an 60-3, 8 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />