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---_-- Application for Exemption FORM <br /> N9hncke0e antef <br /> 11�G�1I/LG GC from Motor Vehicle Taxes.by Qualifying Nonprofit Organizations 4 � <br /> •TO be flied with your county treasurer. <br /> •Reed lnatnmtions on reverse aids. <br /> Applicants Name Type of Ownership <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA,INC. ®Nonprofit <br /> Street or OthherMelina Address ^County Corporation <br /> PO BOX 1863(DOM: 1804 S EDDY, GRAND ISLAND NE 68801 HALL ❑Other(specify): <br /> OW State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,ZR Coda <br /> . <br /> SEE ATTACHED LISTING <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,If necessary. <br /> Registrittan Data or <br /> Motor Vehicle Make Model Year Body Type Vehicle lD Number Date ofAcquishlon. <br /> If Newly Purchased <br /> CHEVROLET 2017 - LT SON ALTO 1G1BESSM9H7230901 11/2712017 <br /> Exempt Uses of Motor Vehicle: I''I Are the motor vehicles used exclusively <br /> ❑Agrlcuiturakforticultural F:< Educational 0 Religious fl Charitable 0 Cemetery as Indicated? <br /> Give detailed description of use,Including an explanation U MA*ase classiJicallons exist: H YES ONO <br /> Used for picking up and taking home clients. Also used for support of clients activities and No,give percentage of exempt use <br /> training. <br /> Under penalties of law,tdedare.that I have exarrinedihls apfloaubn end that It le,CO the bettor my knowledge and belief,true,complete,and carect.l <br /> also declare that I am dulyauthorized to sign thisexempton application,end that the organization owning the-ebove•gsted property does notdiacdmIatte <br /> in membership orerrptdyment based on race,color,ornationalorigin. <br /> ysign p 'tT, o 1 7 <br /> Jere IA • •Si._ :,, - TNEa Dtita <br /> I FOR COUNTY TREASURER RECOMMENDATION <br /> (gAPPROVA1. RECEIVErrit"b Per lass& <br /> o DISAPPROVAL <br /> DEC 1 3 2017 lo- eta 0401k. Hw t�olkeu�,�ltbtavu , lehdati <br /> FOR.COUN'V BOARD OF EQUALIZATION USE ONLY r �. <br /> HALL COUNTY <br /> TREASURERS OFF <br /> , APPROVAL. GRAND ISLAND,NEBRWMEt.TS: <br /> QDISAPPROVVAL / <br /> :. . % if _ /_. --(1,-CD/id,C917 <br /> uthwhed >, at Tr Date <br /> Nebraska Department al Revenue Authorized by Nab.Rea States 77-2o2(1)(e)eruf(m and60.1,le5,and 604,160 <br /> 95-253,2006 Rev.8-201 1 auperaadea 82534006 Rev.54009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS, <br />