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11!0612017 1428 TR P.0021002 <br /> g <br /> --ter Application for Exemption <br /> Wands M <br /> N <br /> from Motor VehicleUrsa by Qualifying Nonprofit Organizations <br /> •TobeN w yut. 457 <br /> •Read InNNnton.on fern. <br /> Apprkent's Nana Type of Ownership <br /> GOOD SAMARITAN SOCIETY GRAND WI.AND VILLAGE D31 Maproll <br /> Street or Other Meng Address aumy OaporaUyn <br /> 4078 TIMBERLINE ST HALL ©Other(epoary): <br /> Oily State Zip Code Mme Where Nwctpasad <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> This Nam,Address,Clty,State,Zip Code <br /> See att6e JA _..._. <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> *Attach an additional sheet,if teeessary. Oaks or <br /> Motor Valois Make Model War Sad,'TYA. WI%lS*ID lambed Date aiAo+ $Ucn. <br /> II Newly Purchased <br /> see teal <br /> Ereaa,t Uaea of Make Yalta N.the Mohr waist and eSualvely <br /> ©Aprladturalmontultu(W 0 Pdueedaw ai Rsdp ous , . miss° 0 Cemaxy ea egaaled? <br /> Give detains'daDCS)n of use. artaxplens, d v� 1�YE8 ONO <br /> At 1 ,: ,I"r. 7.1y .— /d1 YN If NO,ONO WrteNtlda ofa[aapl nn: <br /> it Odd it •t � a I <br /> Wuododar.detismduly gdynadet*+ epptloadon.and Ides the pn,perlytloeanotdlaa9mY,ata <br /> In m almrehp or implement based on roe,Odor,at rtasanat atpk, <br /> sign R. �, � � ) , 17 <br /> here � » <br /> RECEIVE` 001011W TREASURER RECOMMENDATION <br /> S'A P P R O V A L COMM e N 41,5:3: 14'77--404,2—, <br /> 0 DISAPPROVAL NOV 7 2017 <br /> HALL COUNTY SIC-taaaltd9 er Dale <br /> tREAJJRCR NOAflD OF EQUALdZA11ON USE ONLY <br /> GF2ANQ 1 <br /> tAPPROVAL COMMENTS: <br /> DISAPPROVAL <br /> ilk <br /> f— 5'—/S" <br /> s✓pn.tare — bete <br /> — d nowt* kneadadty Nat nes Sail n-a*OKel old 0A,eea antes.and Ibatae <br /> memos Boos Pen bat I Iuperaha e64b.a a tba sax* <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />