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2al gi <br /> NnI�;r►�„t-.-, „a; Application for Exemption FORS, <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type bE Ownership <br /> GRAND ISLAND AREA HABITAT FOR HUMANITY (� Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 502 W SECOND ST .P0 00)fi-004 HALL <br /> ----'----_--- --f ❑Other(specify): <br /> City --- State ----- Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE -888e2 6:48O i NE --._._._.---._.._. <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Tide I Name,Address.City,Slate,210 Code <br /> .32rcia-cc✓it- 13Yicin�.r.LaLthzJ-jtL.W^ISNn*_Cr2 aJE-toSKol--- - <br /> V. ?. M.a4EBrnnr i�,. za_W iwenir a C> S_NE G_Tr803 _-- °- - --_-_-_ <br /> 5esrr-I-o- __..._.-_.-._.Jenrir•Ct! Berri -k 104 l_aKevjew ('art✓It, Grt I.SE &8803 - <br /> Tre-asu.rr.,- Idol.n Isbnt7 i 422. Romanej beck, tez ME ago <br /> ._ <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> I ' Registration Date or <br /> Motor Vehicle Make Model Year I Body Type Vehicle ID Number Date of Asqulshnon, <br /> • _ ....--.-.----.-_.—...—_._.-___ •__._f Newi�r Purchased .. <br /> .6_13✓.----------------- & S_.-� - — <br /> u 5 Loaawv-e r KS I el q R. 1 tidy i-ra.r a u i 1.4A C S 18 22 w 7 o 0 S&3 <br /> Can't t J 12.000Y CArsa .r+rails 4x4--rsEg25YN0%103 <br /> il-t_ici arraslrx ZOOS . FIAf- 'SS Li a afs82Xfia07t$kLi <br /> Hemp rvtdr. 20(3 • ,t,Zwhc trail::et <br /> Exempt Uses of Motor Vehicle: ----. --_-i Are the motor vehicles used exclusively _.J <br /> o AgriCUkuralMorticulfural 0 j Educational 0 Religious hantatre ❑Cemetery I a>indicated? <br /> Ghee detailed description of use,including an explanation if multiple use classifications exist: YES ONO <br /> Vekrcles/trxile.rs art usa -For i-r-ansport- an el 5+15 rale of <br /> +polsf t .t.-pp ry.ta*, S1.c.(oPl its a A. rid na*ibn5 +4.0.{- Supeor"r In No give pomen ageo exempt use: <br /> 44- w.-rlc OCr him" 0rg ay.r2_a--I-i9n . <br /> vJJ <br /> Under penalties of law,(declare that I have examined this application and that It Is,to the best of my iewMedge and belief,true.complete,and correct I <br /> also declare that I am duly authorized to slop this exemption application.and that the olganlzetion owning the above-listed property does not discriminate <br /> in membership or employment based on race,coley;cs national engin. <br /> sign .41lt_ effect kcbire_dr-r- 1143)17 <br /> here ►Authorized Signature The Date <br /> L_ — —_- FOR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL RECEIVED CONTENTS: scr-a2tirila. r .ie 5.,5- A 77-a°ta <br /> D DISAPPROVAL _ <br /> DEC13 2017 -•------------ ------------------------- --------- -----._.. <br /> ®Signature of County Treasurer flele <br /> I __ su G n, OR COONTY BOARD OF EOUAUZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> • <br /> PPROVAL COMMENTS: <br /> 0 DISAPPROVAL <br /> ��••':tl St�nb,ura — -__----------- Dare <br /> Nebraska DePtmnent of Revenue AW+enzed by Neb.Rev..:,tat.le 77-202(1)(c)and(d).and 604,185.and sea pas <br /> 36:53.+008 Rev.8.2011 Su erseaes 98-253.2005 Rev 5.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />