Laserfiche WebLink
-- I Application for Exemption �g <br /> N�eroC.gu 1 em�oEwu Cof <br /> RGVEiNUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations � � <br /> iN *To be filed with your county treasurer. <br /> •Read Instructions on reverse side. I <br /> Applicant's Name I Hype at Ownership <br /> GOOD SAMARITAN SOCIETY WOOD RIVER <br /> Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1401 EAST ST HALL <br /> El Other{specify): <br /> City State Zip Code State Where incorporated <br /> WOOD RIVER NE 68883 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> This _ Name:Address,Cag Slate,Zip Code _.__ - _____ <br /> Please see attached. . . <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> GMC 1991 SIERRA 1GTEK14KXME516506 <br /> FORD 2007 FREESTAR 2FMZA52247BA0276D <br /> FORD 2011 CUTAWAY (BUS) 1FDFE4FS5BDB22694 <br /> DODGE-BRAUN 2014 WAGON 2C7WDGBGOER2203_ 5 <br /> Exempt Usss of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑i Agriatltural nkuduai ❑Educational gReliglous ❑Charitable ❑Cemetery as Indicated? <br /> Give detailed description of use.Including an c <br /> rug explanation use Aassii'xafiore exist: YE,, ONO <br /> The general use of vehicles is to transport residents to If No,give percentage of exempt use: <br /> medical appointments, to and from hospital stays and <br /> recreational trips such as State Fair and parks. <br /> Freestar is for staff to go to meetings, staff education, and the <br /> Sierra is for maintenance department, hauling, etc. <br /> Under penalties of law,i declare that I have examined this application end that it is,to the best at my knowledge and ballet,true,complete,and correct.I <br /> also declare that I am dully authorized to sign this exemption application,and that the organization owning the above-listed properly does not discriminate <br /> In membership or employment based on race,color,or national origin. <br /> Sign �—t : is e , .- --- — 1 za4 iunnsMEkL. D/L-,41._L; <br /> here <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> 445; S" 77-4e <br /> APPROVAt <br /> RECEIVED)MMUS U /1142"1--- <br /> DISAPPROVAL <br /> DEC 6 2017 s }�f -°'/ /�-�7—,7 <br /> It Signature of Treasurer Date <br /> 1IALL COU-FOR COUNT.'BOARD OF EQUALIZATION USE ONLY I <br /> - -TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL WMMCPI f S: <br /> ❑DISAPPROVAL <br /> is <br /> A t O x11 <br /> 1 w.,9-4— — ///_�r/. <br /> • A <br /> , hori =•Signature Date <br /> Reba te:s Destined of Revenue Authorized by Neb.Rev.Stet.§§77-202(t)(c)and(d).and 60-3.185,and 60-5.iSC <br /> aR-253-2006 Rev.6201:Supersedes 04253-2005 Rao.5-20(4 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />