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J,,OI v <br /> • <br /> Ner�- Application for Exemption FORM <br /> braska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> Overland Trails Council Boy Scouts of America ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2808 O'Flannagan St. Hall mother(specify): <br /> City State Zip Code State Where Incorporated <br /> Grand Island NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> President Mark Mowry,3220 Cottonwood Ln.,Keamey,NE 68845 <br /> Treasurer Ron Vonderohe,4218 Michigan Ave.,Grand Island,NE 68803 <br /> Secretary David Plond, 1519 W.Division,Grand Island,NE 68801 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year 8odylype Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> Ford 1989 Pickup 1FTDF15N1KLB07506 <br /> _ <br /> Dodge 2008 Mini-Van 1D8HN44H188172132 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural IX Educational ❑Religious ❑Charitable I9 Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: tj YES ❑NO <br /> Ford and Dodge are used at camp for camp operations. <br /> If No,give percentage of exempt use: <br /> Under penalties of law,I declare that I have examined this application end that it is,to the best of howled and belief,ted property complete,and correct I <br /> aPW my lie P & cL <br /> also•• =re that I am duly authorized to si'. -exemption nal o.atbn,and that the organization owning the above-listed property tloes not discriminate <br /> in era '. �, employme = - color,or natimal origin. <br /> sign tit l Scout Executive 11/10/2017 <br /> here Authorized Signature - Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> A/S ! ' <br /> �Ov <br /> Q PPROVAL R EGEJ "1 /_�' ' .0 , <br /> ❑DISAPPROVAL <br /> NOV 1 5 201) / ` htaut/v /...?-.7,r-,7 <br /> -Ignature of County Treasurer Dale <br /> FOR COUNTY B'MD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> APPROVAL GRAND ISLAND NESOMMeNTS: <br /> ❑DISAPPROVAL ill r ` <br /> Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rey.Slat.§§77-202(1)(c)and(d),and 60.3.185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 98-253-2098 Rey 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />