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01/03/2018 11:31 3083824033 ffa P.002/002 <br /> rakes, ,, Application for Exemption FORM <br /> REM from Motor Vehicle Taxes by Qualifying Nonprofit Organizations w <br /> •To be filed with your county tyrant 4 <br /> • •Read batnicbons on reverse aids. <br /> Appllcam3 Name Type of Ownership• <br /> GSS.Hastings Village Home Health ®Norpdt <br /> Street or Other Mailing Address. County Corporation <br /> 3415 W State St,Ste B Hall D Other(eva r)- <br /> ON State • - by Code Slate Wham Incorporated <br /> Grand Island. •NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,AddR9s.Only,Stets.Zp Code • <br /> Director Liza Nelsoft,3415W State St Ste b <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an Wittenelsheet if necessary <br /> Registration bale or <br /> MotorVehfole Make Model Year Sodyl)Pe Vehicle ID Number Date � <br /> CHEVROLET 2013 IMPALA , • 2GIWF5E35D11114$0 1/2017 <br /> CHEVROLET 2011 IMPALA 2G1W05EK4$4235513 1/2017 <br /> FORD 2000 FUSHION • 1FAHP35N59W257445 1/2017 <br /> •Exempt Uses Motor Vehicle: _ Are flit r vehicles used ewlusively <br /> ❑AgrioulturaJRorlmuiwrai 0 Educations] ®Reigbus 0 Creatable C]C9meYry as indthabse? <br /> ONe detailed description of use,including an aplanation if multiple use claWnmibns exist: OYES 0 NO <br /> Nurses and nursing aides use vehicles to drive to the home of Slants to provide care. <br /> if No give percentage of eNemp use, <br /> Under penal*of Itn,I Odin that I have examined We appicatkn and that it le,to the best of my bnowkdge and belief,tut complete,and cornet.I <br /> also Man Intl am duly authorized m sign t ienempign ePOICS.SON dad t that the organization owning the above-listed propertydoes not discriminate <br /> in meemmherehp/o`/r/eitPoyment bend on vacs,cote,or national origin. • • <br /> Sign , / ,� OffceManager • 1/3/2018 <br /> here A xl ern 89yeaaoe rift Data• <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> AP OVAL RECEIVED waits: . , t-- A./s a77,4c7d, <br /> ❑DI PROVAL <br /> NOV 2 7 2017 l 47-48-/7 <br /> ■signature Cou reasuver , Cana <br /> . - FO COUNTY BOARD OF EQUALIZATION USE ONLY I <br /> GRAND <br /> TREASURERS OFFICE <br /> ISLAND NEBRASKA P MMENTSf — <br /> a <br /> '. 04,-(Z-Her- ---- 1- 1-7 5' <br /> ❑DISAPPROVAL <br /> Dam <br /> Nvbraoa bopammet cfnvmrve Aamedue by Neb.Flair&srn 71-202 H9and(N.sea 609,186,-109.wn <br /> e6-2s3 COe inv.a-2011 Supersedes 95.255.2006 Rev.s100e <br /> PLEASE RETAIN A COPY W,RYOUR RECORDS. <br />