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gr , Application for Exemption FORM <br /> Nabrny napernnanr M <br /> from MotorVehielaTaxes by Qualifying Nonprofit Organizations <br /> To be filed with your county treasurer. <br /> •Read Instructions on raven side. <br /> Applicant*Name _.__ _ _— Type-of Ownership.... <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA,INC. 0 Nonprolk <br /> Street or Other Mailing Andreas... County Cerper tlen <br /> PO BOX 1863 (DOM:1140 S LINCOLN AVE, GRAND ISLAND NE 68801 HALL ❑Other(snooty): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tine ..- Name Address,OA,Slate Zip Cede <br /> SEE ATTACHED uenf S _ <br /> DESCRIPTION OF THE MOTOR VEHICLES. <br /> •Attach an add ttonal-sheet,If necessrlry. <br /> ReglaeaUOn pateor <br /> MotorVehicle Make Medal Year 5odyrype. Vehicle ID Number Date of Aequlatdon, <br /> If Newly Purchased _ <br /> WABASM-NATION 2002 SEMI-TRAILER 1 JJV532W92L7805455 01115)201a <br /> WABASI4NATION 2002 SEMI TRAILER 1JJV532WO2L737555 _ 01/4%018 WABASH-NATION 2D02 SEMI-TRAILER 1JJV532WX2L787414 0tl1EE/2018 <br /> Exempt Uses of Motor Velilcte: Ate the vehicles used exclusively <br /> ❑AgrlcukunNbnlcubural ig Educational ❑Religious ❑Charitable 0 Cemetery as Indicated? <br /> Give detailed description of use btcktdingan explanation If multiple useclasWfloadon sexist EYES 0 N <br /> Used for hauling/collecting donations that support our disability programs. It No,give percentage of exempt use: <br /> Under penalties of law,I declare that I haveexamined tieappneatIonend that It Is,tothe best of rig knnvdedge and belief,true,nninnkte.and correct.I <br /> also declantltst I amdnlyautledzed to sign thaveaampaon applloatln.ardtiat the orgeribdien Owning the above-bated properly does notdisodninate <br /> in mamaenhlp or employment basedon raoe,poke,or nationalorigin. <br /> ere • <br /> I 1 Aanadzedd eiggna The Date <br /> FOR COUNTY TREASURER RECOMMEENDA1ON <br /> APPROVAL <br /> ��RECEIVED " /v qC ca 2- <br /> ❑DISAPPROW,L <br /> FEB 1 2018 ,ii I-a —/°4P" <br /> Slgnatureof,.uny Treasurer Date <br /> _ HALL COUNTYFOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> mcMauraexaurr n..e <br /> GRAND ISLAND,NEBRASKA <br /> ❑APPROVAL COMMENTS: <br /> o DISAPPROVAL ` <br /> -et 440111‘" <br /> 4117 orizedSignaNn. Date <br /> aapresxe Depanmentef ae wiue Awhonzed by Neb.Rea Stai:gg`n402(1)(4 and(di:end 6a-9,166,end 60-3,10 <br /> 13e259-2e66 Rev.64011 Supersedes-56-2632006 Rev.52009 <br /> PLEASE RETAIN A COPY FOR RECORDS. <br />