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NFRp Application for Exemption FORM <br /> e ;rent Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> Coos •To be filed with your county treasurer. <br /> ..•.,.E FFEVE„er •Read instructions on reverse side. <br /> Name of Organization Type of Ownership <br /> Grand Island Area Habitat for Humanity © Nonprofit Corporation ❑Other(specify). <br /> Name of Owner of Property County Name State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 502 W SECOND ST DANA JELINEK 308-385-5510 <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68801 dana @gihabitat.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address.City,State,Zip Code <br /> President Brian Schultz,812 W.15th,GI NE 68801 <br /> Treasurer John Nootz.422 Rosewood Circle,GI NE 68803 <br /> Secretary Jennifer Bemth, 104 Lakeview Circle,GI NE 68803 <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Ford 2015 Cutaway E350 Super D 1FDWE3FS5FDA21476 8/13/18 purchased <br /> _ <br /> - <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ❑Educational ❑Religious 0 Charitable ❑Cemetery as indicated. <br /> Give detailed description of use,including an explanation if multiple use classifications exist: El YES ❑NO <br /> Used in the transport and storage of tools, equipment, supplies and donations that support <br /> the work of the organization If No,give percentage of exempt use: <br /> Under penalties of law,I dec that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> I also that I am duly hor ed to sign this exam on application. <br /> sign A444-- �� Executive Director 8/20/18 <br /> here ■Authorized Signature Title Date <br /> For County Treasurer Recommendation p� �f r1 <br /> VApproval RECEWEDCommnts: ( m�x 6 �kW 71.202 <br /> ❑Disapprove^ <br /> AUG 2 0 2018 1n x,/f <br /> 11 ig of County Trees e e <br /> HALL COUNTY For(aunty Board of Equalization Use Only <br /> TREA:JRERS OrFICE <br /> GRAND ISLAND,NEBRASKA <br /> Til Approval Comments: - <br /> ❑Disapproval (Th <br /> Apr•rized Signature �_ Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(11(c)and(d),and 60-3.185,and 609.189 <br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2006 Rev.8-2011 <br /> Please retain a copy for your records. <br />