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ablg <br /> +dam---z- Application for Exemption FORM <br /> Nebtas1a Donartmenl of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 437 <br /> •To be died with your county treasurer. i <br /> _--_ •Road instructions on reverse side. <br /> AppGCant's Name Type of Ownership <br /> GRAND ISLAND DIVE AND RESCUE TEAM [?Si Nonprofit <br /> Street cr Other Mailing Address I County Corporation <br /> 3107 WOODRIDGE BLVD HALL <br /> City _-_— _.--- State Zip Code_--_— I u other(specify): <br /> State Where IIncorporated .5 YS: <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address.City,State,21p Code <br /> Pea'SLgaM)_--_--6_6-66_--10at6a_L. .aseol tint( , tg-__tic ,s_lx d.sc,/4 .t/C- Bol <br /> V n d&-AAern, -c if.,_l_z4 . xi 'v. _-_illir C*s /st ...ALE <br /> 6 iffe4-I 6666-- <br /> --------------6666---- --------------------------------...__----------------- <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach art additional sheet,if necessary. <br /> 1 I i '; Registration Date or <br /> Motor Vehicle Make 1 Model Year I Body Type i Veleta ID Number I Date of Acquisition, <br /> ? <br /> _.� _ I L It New!y Purchased — <br /> .le _01_14.s o___—__V44 .g02,3-!errs.,rr.X_ c1._Isl.Ce_a�f&ffM 4.2 _CC_-.5.6 SZ._.._._ <br /> 2603 /-Z3-OR R)(Y4/9 1 <br /> Exempt Uses of Motor Vehicle:_ —__l_ �Are the motor vehicles used exclusively <br /> 11 AgriculturaLMeriialtural ❑Educational ❑Religious jChadtable [_i Cemetery l as indicated? <br /> Give dawned descrtlion of use,including an explanation if multiple use classifications exist: . YES `NO <br /> rs s-_rizemc_a usa-n r&7 a AU .Roar v e gesace <br /> --ES{frsPM_ .!r_, !2__Ridef -eri,IEE_Sni-na J by 47T IIE' J e) i a No give percentage of exempt use: <br /> sassy__kaffe_ Raaen79dicG�sD�ier-as t Atr,�Gttera_._an.L £'t-__. <br /> __MA_ir_A "b /jam anto_.Fait_ .-_Sa4-ES?Y_7Fe.Rnttctt. <br /> ____44,44 JAJ &1 ALE_ 12 Oneme. .rtasrsa_TCSwws <br /> I <br /> Under penalties of law,I declare that I have examined this application and that it Is,to the best of my ioowiedge and begef,true,complete,and correct.t <br /> also declare that I am duly authorized to sign this exemption app le:O ,and that the organization owning the above-listed properly toes not discriminate <br /> in membership or am t based on race,color,or national origin. <br /> sign ,'Gl62/�,�� T.ee("non - n-a z - i? <br /> here Aulhadzed s. lwa / The Date <br /> [ — . FOR COUNTY TREASURER RECOMMENDATION <br /> it.—_ _--_._ �_—_.—. <br /> [APPROVAL RECEIveDENTS: At-- 41„x.5. 77_Z20A <br /> C.'DISAPPROVAL <br /> NOV 2 7 2017 I ® �Qa�L a'�9�' <br /> Penult/re Treasurer <br /> Dale <br /> __...L___________ ��J'�j�9ptg LLINTY MARC OF EQI IAI?7ATION USE ONLY <br /> ASU ERS OFFICE I <br /> 1 - TREASURERS OFFICE <br /> GRAND ISLAND NEBRASKA <br /> -AAPPROVAL '- 1.•uwviEnrrS. <br /> []DISAPPROVAL <br /> • . .zed Signature <br /> Netnsia Oepmlme d of Revenue Authorized by Na t.Ray$tat P8 77-202(1)8)and(di.and 80.4.188 and 608.189 <br /> 90-253-2088 Rev.8-2011 SUDS rsaaes 98-254-2006 Rev 5,209 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />