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&tI1 <br /> RAA C1iA <br /> Application for Exemption�. _. ._. .. . pp p FORM <br /> Good Life.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> o<•a,,,E,,.OF REVENUE •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 Properly County Name State Where Incorporated <br /> • <br /> HALL NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> PO BOX 1863, 1804 S EDDY TAMI NABOWER 308.384.7896 X 124 <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68802-1863 tnabower @goodwillne.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State,Zip Code <br /> SEE ATTACHMENT <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 /> SEE ATTACHMENT <br /> Exempt Uses of Motor Vehicle: _ <br /> Are the motor vehicles used exclusively <br /> 0 Agricultural and Horticultural Society as indicated? <br /> Ag' y ®Educational ❑Religious ❑Charitable ❑Cemetery <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO <br />• <br /> USED FOR PICKING UP AND TAKING HOME CLIENTS. ALSO USED FOR SUPPORT OF If No,give percentage of exempt use: <br /> CLIENTS ACTIVITIES AND TRAINING. <br /> Und 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 omplete. <br /> I at dlQdare that I arfi)du uthorized to sign this exemption application. <br />• sign �1)(// <br />• � � � f . <br /> here (•A rued Sig um Title Date <br /> Fr•'r..,,nty Treasurer Recommendation <br /> T. <br /> L ���� <br /> ?prover i Comments: Pik f <br /> ❑ Disapproval <br /> QAteofCo County rer ) ta1t■Ia <br /> F".! CO'LNTY C[ Signet re of County Tre rer Date <br /> Agp„Erounty Board of Equalization Use Only <br /> AApproval Comments: <br /> ❑Disapproval <br /> x,y l • L5 <br /> thori.-•Signature Date! <br /> Nebraska ueparimanl of Revenue Authorized by Neb.Rev.Stat.§§77-202(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 />