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Nebraska Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations be•H n tru ns orAontreasurer. 457 <br /> to county ree <br /> Applicant's Name Type of Ownership <br /> American Red Cross <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 404 E 3rd St Hall ❑Other(specify); <br /> City State Zip Code State Where Incorporated <br /> Grand Island NE 68801 Nebraska <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Board Co-Chair Denise McNitt 800 Mercy Rd Council Bluffs,IA 51503 <br /> Board Co-Chair Thomas Andreoli 1400 Douglas St Stop 1580 Omaha,NE 68179 <br /> Vice Chair Megan Berry Barlow 700 S 72nd St Omaha,NE 68114 <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Dab of Acquisition, <br /> If Newly Purchased <br /> GMC 2015 Terrain 2GKFLWEK2F6417459 2015 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgrlcuhuraVHorticultural ❑Educational ❑Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanat if multiple use classifications exist: ®YES ❑NO <br /> T"' �A/ , u lJ� - ( .i , / It No,give percentage of exempt use: <br /> \NQue1 ,j 2.. <br /> Under penalties of law,I declare that I have examined this application and that It is,to the best of my knowledge and belief,true,complete,and correct I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membe; ip or em• • em based on race,color,or national origin. <br /> sign <br /> �� 1 Executive Coordinator 1/16/2018 <br /> here A •rized Sign ureW The — Date <br /> '}I p�.•'^F�OpR COUNTYTREASURER RECOMMEND�ATTION di- <br /> • <br /> O APPROVAL CEI,rEN MMENCS: / G.�-- /Z/S.yS_ 77-. ) a_ <br /> ❑DISAPPROVA <br /> FEB 2018 -- ,: y/�" �1� -6-/� <br /> it Signature of County Treasurer Date <br /> HALL COUNTVOR COUNT'BOARD OF EQUALIZATION USE ONLY <br /> TREA burr tr<a OFflCB <br /> `, GRAND ISLAND NEBRASI(A <br /> / <br /> �JAPPROVAL COMMENTS: <br /> ❑'DISAPPROVAL r -, <br /> _/ -2- -2-0 ,-19 <br /> WSlgnature — Date <br /> Nebraska Department of Revenue Authorized Neb.Rev.stet.§4 7 -20 (1)c7 2 antl <br /> by () (d),and 603,185,and 803,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-258-2036 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />