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Application for Exemption - FORM <br /> Good Life.Great service, from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be flied with your county treasurer. Y A 57 <br /> OEPANr.a.,°r REVENUE •Read instructions on reverse side. <br /> Name of Organization Type of Ownership <br /> GIRL SCOUTS SPIRIT OF NEBRASKA El Nonprofit Corporation ❑other(specify): <br /> Name of Owner of Properly County Name State Where Incorporated <br /> GIRL SCOUTS SPIRIT OF NEBRASKA HALL NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 2121 S 44TH STREET JODI M. PREWITT 800-695-6690 <br /> City State • Zip Code Email Address <br /> OMAHA NE 68105 jprewitt@girlscoutsnebraska.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State,Zip Code <br /> CEO FRAN MARSHALL,2121 S 44TH STREET,OMAHA,NE 68105 <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 VAN 1998 VAN 1FBSS31L4WHB00128 <br /> ENCLOSED TRAILER 2008 TRAILER 6'x10' 1DGCS10138M081611 <br /> ENCLOSED TRAILER 1999 TRAILER 41x6' 4X4TSE211XN019853 <br /> FLAT BED TRAILER 1997 TRAILER 24' 44NFH1626VL021679 <br /> CHEVROLET 1992 f PICK 1IP 1GCEK14Z8NE120850 <br /> Exempt Uses of Motor Vehicle: /t/J 7('/ f.�/y►- ��rye%-/)y/f f,n�' Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural aaety 4/ LJ Educational l v❑RRelgio�usl El Charitable 0 Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO <br /> TRANSPORT GIRLS AND ADULTS TO EVENTS AND CAMPS. TRANSPORT <br /> EQUIPMENT AND CAMPING EQUIPMENT, PURCHASING FOOD FOR GIRL SCOUT If No,givepetcentage of exempt use; <br /> EVENTS. % <br /> Uncle 'n: -s of law,I d, la -that I :T e: :mined this exemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> I also.: lare that am duly:ut . 'zed to 4!!!111 .,-, .ion application. -7 �/ <br /> sign , t y t' CFAO {((t"iGI((s✓t(Y <br /> here Authorized Sign; Title Date <br /> �...//�1 For County^Treasurer Recommendation (��y h� <br /> ltA/cpproval Comments: 1 P,u.ISSS 1 lr3tJ u <br /> tY <br /> ❑Disapproval <br /> r Q4 }�1�/� t{�/t1 ` p <br /> It Signehha�of County Treas� 'v\WV%Date <br /> For County Board of Equalization Use Only <br /> PCB <br /> •9 Approval Comments: <br /> ❑Disapproval - <br /> Autho zed Si.nat[. -- Date / <br /> Nebraska Uepanmenl of Revenue Authorized by Neb.Rev.Shat.§§77-202f 1)(c)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 />