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12111►2018 1737 ENO P:0061007 t 15 <br /> rR�_ Application for Exemption <br /> ?DVS <br /> M <br /> Good Life.Great Service. <br /> from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> *To be tiled with your bounty treasurer. A G7 <br /> .....ear«YYOYM •Reed InsGUa tons on reverse aide. `tJ I <br /> Name of Oltaftithn -1 We 01 Ownership <br /> GOOD SAMARITAN SOCIETY GRAND ISLAND VILLAGE 2 Nonprofit Capomfion ❑Other(specify): <br /> Name of Owner of Property County Name Slate WNW*incorporated <br /> HALL NE <br /> Street or Oter Mang Address <br /> Name Contact <br /> uk Phone 32,y—;t.,_ <br /> Cry � <br /> COW EmNl Address <br /> GRAND ISLAND Slate Zip NE 68803 aL.Sh-"pC o I a ,D&-SOIYYl. cn <br /> Y <br /> Identify Officers,Directors,or Partners of the Nonprof( rgeni n <br /> Title Na/m�e,AndreaAndreas.e�eas.Cily,,Stale,Zp Cade _ <br /> Description of the Motor Vehicles <br /> •Attech an gddN(onai sfley N 0e060bary• <br /> MabrYahath Mile Modal Yee Replahadan Dab or <br /> Body type VeMels 10 Number Oath ofAaquthfuon, <br /> It IMdy PUMbeeed <br /> fr -#ED <br /> Nereid Uses of Molor Whir* Are the motor vehicles used exclusively <br /> ❑Apnetlftnl and Nonkulatml Solely ❑Eduaada,d Religious 0 Charitable 0 Cemetery as indicated? <br /> Give dewed description at boa bldudi1p an explanation if multiple use classification train: ;YES ❑No <br /> - <br /> F 1l1 11A1�` a • . . II N0.OM PS entage M exampl use <br /> rof that I e rasa�,epdkadenand.lo Me ben ef myfmowledae and betel,Os correct end mrpieta <br /> sign <br /> • / wvN1�- rte- ii g.15-19# <br /> here I Authorized Signature <br /> ,. �„ <br /> f,,��,,^^ For County Treasurer Recommendation n�{ �, <br /> Iproael _... Comm ents: 411410: <br /> Wi) N/7 '}'S11�' <br /> 0CCDisa�Frovai - .>.. . «. , <br /> i , ►Signatum- of County�lp'uuM l�,k,� <br /> I CEO 1 i".3 far county Board of Egusu llon use Only Oe <br /> • <br /> yApp C('mmentt <br /> I ,. .. <br /> ❑Disapproval / <br /> as <br /> rIsaac Depwlaaal ii R vein N,ec,ved lyNea soy.St .u fl 112(1Xe)as(dp eel eoafl8,and 80 180 <br /> a-2534000 Rev.7-ecte Ouparait.P14156-200514w.33011 <br /> Please retain a copy for your records. <br />