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Application for Exemption FORM • <br /> Good Life.Greet Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> „....Vain •Read Instructions on reverse side. <br /> Name of Organization - Type of Ownership <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA, INC. ®Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property County Name State Where Incorporated <br /> GOODWILL INDUSTRIES OF GREATER NEBRASKA, INC. HALL NE <br /> Street or Olher Mailing Address Contact Name Phone Number <br /> PO BOX 1863(DOM: 1804 S EDDY GRAND ISLAND NE TAMI NABOWER 308-384-7896 <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68802 accountspayable @goodwillne.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State,Zip Code <br /> SEE ATTACHED LISTING <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> CHEVROLET 2018 CRUZE 3G1BE6SM2J5630036 10/26/2018 <br /> CHEVROLET 2017 CARAVAN 2C4RDGCG0HR828399 10/26/2018 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> El Agricultural and Horticultural Society Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation II multiple use classifications exist: ®YES ❑NO <br /> Used for picking up and taking home clients. Also used for support of clients activities and <br /> II No,give percentage of exempt use: <br /> training. <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,It is correct and complete. <br /> I[668 declare that I d authorized to sign this exemption application. <br /> sign � 'ftil • a� v /i <br /> here Authon ed5 at Dale <br /> For County Treasurer(Recommendation <br /> ( R y' Commelts: '`�E1n a0� <br /> C pproval 1ist..v i �L.Li . <br /> '❑Disapproval NOV tilfl� .I y 2018 ,Signature of County Treasure Date <br /> � ���'I� <br /> I For County Board of Equalization Use Only I <br /> —MALL I.VUINIY <br /> TREASURERS OFFICE <br /> ❑Approval GRAND ISLAND,NEBRA. G „nts: <br /> El Disapproval , <br /> i <br /> 1 <br /> �' ,, � � // — ) 7— / 25 <br /> Author Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.88 77-202(1IIc)and(0I,and 60.3,185,and 603,189 <br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2006 Rev.1-2011 <br /> Please retain a copy for your records. <br />