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-- ate Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be tiled with your county treasurer. <br /> saramm <br /> •Read Instructions on revers.side. <br /> Applicant%Name _. 1ype of Ownership <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA, INC. ®Nonprofit <br /> Street or Other Meaing Address courtly Corporation <br /> PO BOX 1863(DOM: 1804 S EDDY,GRAND ISLAND NE 68801 HALL 0 omer{npecity)a <br /> City State Zip Code Sate Where Incorporated ... <br /> GRAND ISLAND NE 68802 NEBRASKA <br /> _ <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> title ,Nome,Address:City,State,Zip Code <br /> SEE ATTACHED LISTING <br /> DESCRIPTION OFTIIE MOTOR VEHICLES <br /> _._. <br /> •Attach an additional attest,If necessary. <br /> MotorVehkle Make Model Year <br /> Registration of Acquisition, <br /> aodrTlTa Vehicle ID Number Date of Putehak6, <br /> It Newly PureMSed <br /> DODGE . 2017 GRAND CARAVAN 2C4RDGCGOI-R557523 :348,2018 <br /> DODGE 2017 GRAND CARAVAN 2C4ROGCGOHR783271 3/26(2015 <br /> Exempt Uses of MokrVehkte: _ Are the motor vehicles used exclusively <br /> ❑AgriculturaNiorticuhural 0 Educational ❑Religious ❑Meltable ❑Cemetery as kldlnled7 <br /> Give detailed description of use,kitluding an explanation if multiple use classifications exist I YES ONO <br /> Used for picking up and taking home clients. Also used for support of clients activities and Ii No,give percendags ofexwnpI use <br /> training. <br /> Under penalties of law,1 declare that I haveexamined thiseppecationand that Cis,to the best of my kiovtedge and belief,aue.complete,and correct.I <br /> elsedeclare Chat I am duly authorized to sign this exemption application,and that theorganizahon owning the ebote4isted propeaydoes notoscnminate <br /> in membership or employment based on race,color,or national origin. <br /> Sign ► GpAs t C. Ff 3 at I <br /> here Aumpnzed Signet Title pa <br /> I FOR COUNTY TREASURER RECOMMENDATION <br /> /VS,J" °67 7 -c20�lfiriew, B9MMENTS:122-4—j <br /> ❑DISAPPROVAL RECEIVED <br /> MAR 2 8 2018 I Srgnaw NTreesuter Date <br /> i FOR COUNTY BOARD OF EOUALIZATION USE ONLY f <br /> HALL COUNTY <br /> [41 APP 10VAL TREASURERS OFFICE Cl$v1MENTS:.. <br /> GRAND ISLAND,NEBRASKA <br /> ❑DISAPPROVAL <br /> 4-- r-e-Ta_a/L-44,--pc) ie/s/ie <br /> Oalla <br /> Nebraska Deprlment of Revenue Authorized by Nett Rw.Star Sfi77-4020)fc1 one tdl,and e0-3,185,ena 6113.180 <br /> 95-253.2006 Rim 5-2011 Supersedes 964632006 Rev.5.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />