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+ben.----e_— Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •TO be filed with your county Measurer. 457 <br /> camoungarsizo •Read Instructions on reverse side. <br /> Appicant's Name Typeof Ownership <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA, INC. ®Nonprofit <br /> Street or Other Mating Address County Corporation <br /> PO BOX 1883 HALL ❑Other(specify): <br /> City State BpCode Stale Where Incorporated <br /> GRAND ISLAND NE 68802 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Tate Name,Address,City,State,Zip Code <br /> SEE ATTACHED LISTING <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Data or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> WABASH-NATION 2002 SEMI-TRAILER 1JJV532W42L788011. 01/082018 <br /> Exempt Uses of Motor Vehicle: Ate the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural r Educational ❑Religious ❑Charitable ❑Cemetery °vmdicated? <br /> Give detailed description of use,including an explanation If multiple use classifications exist: EYES ❑NO <br /> Used for hauling/collecting donations that support our disability programs. <br /> If No,give pe den age of exempt use: <br /> Y. <br /> Under penalties of law,I declare that I have examined this application and that ale,to the best of my knowledge and belief,true,complete,and correct.] <br /> also declarethat I are duly authorized to sign this exemption application,and that the organization owning the above-listed propertydoes not discriminate <br /> in membership oremptoytnenl based on race,color,or national origin. <br /> sign 6. 0 ___11134_12_ <br /> here/Authorized 8ig This Date <br /> FOR COUNTY TREASURER RECOMMENDATION I /0,7-4: <br /> APPROVAL RECEIVE ENrS: of--��E Alta-, <br /> ' ��_ <br /> ❑DISAPPROVAL <br /> JAN 1 2 22018 L Q-e9bir bIQe--2.4,2' /'/,R- /or <br /> "'Signature of County Treasurer Deaf <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> gAPPROVAL GRAND ISLAND,NE@lpt misvi-9 <br /> ❑DISAPPROVAL a <br /> ed.Signature ate <br /> seeress department of Revenue Authorized by Nee.Rau,Slat,9f 77-202112(c)and(d),and 663,186,end 6e-3,189 <br /> 96252.2006 Rev.8.2011 Supersedes 86-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />