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N_B ACK Application for Exemption FORM <br /> from Motor Vehicle Taxes b y Qualifying Nonprofit 9 Quali in N rofit Or anizations 457 <br /> Good Life.G real-Service. s <br /> •To be tiled with your county treasurer. <br /> E•..,,,•, ....e.. •Read instructions on reverse side. <br /> Name of Organization Type of Ownership .SU1 /C\ 3 <br /> VOi`C onprofit Corporation ❑Other(specify): ( ) <br /> C or Co lomPQnion An m2,S <br /> Name of Owner of Property Count'Name State Where Incorporated <br /> (Same\ gall NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> Po 501c 5a56 Robyn mays 30?)-3°f 1-1396 <br /> City State Zip Code Email Address <br /> Grand 'Island NE (pcaDa armays cp&tto- ligmai 1 . Corr\ <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State,Zip Code <br /> Rob4n irf1615 - Pttider4- ,Qltt SL.e.u,cod RA Crand ITS land (\la bS-3 <br /> 5a—� t"iarr+sx.v.-V, iareS. 3it8 Coue3e. 5+ Cornnd SS1and i4tE ;$D6 <br /> Mane 0.er6- Sec. t"Tto3 Arlo- S1- Grag" A tS10trc3 NIE 1o�5WC 3 <br /> Gmi`l ctt zosa, 4■\ rn;l1 64. IT,ar�nebro NE ObaS <br /> oar,aQa 'Mays g1k1 sheruwr- r Rd Grano \@v10 ME tob9-1O3 <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModetYear Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Ford awe, c-35o cord° van IFTSE34C,280A(oosa'] /Fab-IB <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ❑Educational ❑Religious ®'Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: [ YES ❑NO <br /> Deliver pet rood u-SU tins -1-0 seniors a- veeranS. <br /> If No,give percentage of exempt use: <br /> Piece op (lona:Irer} eer -Pod d- Sup p!ie.S . r <br /> -Traneport.. a.nZmotA5. <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 also declare that I am duly authorized to sign this exemption application. <br /> sign (�, .� R •Y� E' ,� t\.-a-t-aolb <br /> here 11AUmori>w' ainnn 6� °� 'Title Date <br />• For County Treasurer Recommendation FCF V D <br /> wpproval Commen s: Pik`N <br /> I 1-aaa <br /> NOV 2 7 2018 <br /> ❑ Disapproval /� f� ,, _ <br /> HALL COUNTY , 1 1 Il o!' J�` nt, 24 <br /> TREASURERS OFFICE al "`""""rrr"`I(^((^"' U <br /> GRAND ISLAND,NEBRASKA Signature of County Treasurer ate <br />• For County Board of Equalization Use Only <br /> S pproval Comments: <br /> ❑'A Disapproval <br /> _ . - . I el <br /> �etl Signature / Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77202(1 kd and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2006 Rev.8-2011 <br /> Please retain a copy for your records. <br />