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�i t <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 /> Appkcanrs Naas Type of Ownerslep <br /> CRISIS CENTER INC (ii Nonprofit <br /> Street or Other Mailing Address I County Corporation <br /> 2251 N WEBB RD PO BOX 5885 I HALL <br /> !—I�'a <br /> Other(spe dyj. <br /> City State Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE 68802 I NE I —_—___-_-- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> The I Name,Address.City,Slate,Zip Code <br /> _Ent_ Tea a 't 'r,' c 1. � u0. ! li I it . ` I e ' Q T GIY+ �Ny , iS1i0 - <br /> e,l t, t� E - -- • O.e..r..1_QQ_.&Qxi3Q► y. d . 40.0A. <br /> i5�. <br /> M. m'0. r: i . - is P• '►X A • "' _ qi. , —o <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet it necessary. <br /> ! Registration Date or <br /> Motor Vehicle Make I Model Year ! Body Type Vehicle ID Number 1 Date at Acquisition, <br /> _ —�-.— i _H*M. Purchased. __ <br /> ai r- i_oy_I�CilithI d E_-_t- r-I©n ___ .3.64Wri Thlial igAMD 1....___________ <br /> ! ! <br /> I <br /> ---I I <br /> I <br /> Exempt Uses of Motor Vehicle: .�...( --hire the motor vehicles used encLSiwv'y <br /> [Agriculturalllortiwltural 0 Educetlonal ❑Religious g Charitable L Cemetery l as indicated? <br /> Dive detailed description of use,Including an explanation it mtatiple use classifcations exist: 1 N[J h'ES ONO <br /> Cgm pi V2)v e&tz am axed to . . , ,Dvf- ' , ; ! /\ <br /> !li No,give percentage of exempt use: <br /> pet 4 f4yf , t.(- to pia tie . 1" 0 y a tJ r t , • • , / )PI <br /> t fr i .R , ► ► 0 1 ) P f / eV1 <br /> Under penalties of taw.I declare that I have examined this application and that it is,to the teat of my knowledge and belief,true.complete,and correct.I <br /> ase--.- lam duly auth •-•to sign this exemption appli cation,and that the organization owning the above-listed properly does not discrirninate <br /> 1n 1r r.or stn•.. . ,:::•on race,color,or national origin. <br /> ' (&OS) 383 8 50 <br /> sign - �1, ' ■ F�(ee vt pi reC�r I f 7 1) <br /> here'i Act .died Signature The tote <br /> FOR COUNTYTREASURER RECOMMENDATION <br /> APPROVAL (per V ant,. i, ..rat.//•-r"" a1/� ,S,SSc #�7— C.Q <br /> (DISAPPROVAL RI�CEIT u ' <br /> NOV 9 2017 go. ,- ar —...__._ /R_R'-,7 <br /> + p,ature; e ity Treasurer Date <br /> 1. ----._ - FOR COUNTY B' RD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> Pi-OPROVAL GRAND ISLAND,NEMMDISITS. <br /> n DISAPPROVAL ♦` deed Vent* "°—�p IS-r—._____.-`.__ /8 L_/.J E: <br /> Netaassa Department of Revenue Au herdzed by Nail Rev.5le1.66 71-202(1)(c and(f$.end 603,185.and 919 189 <br /> 96-253-2036 Rex 52011 Sunerseess 95-253-2905 Rev 52001 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />