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NS A pp lication for Exemption
<br /> I FORM
<br /> from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> Good C.fe.Great service. Y Y 9 P 9
<br /> o.•.•. .,,•r,r.E E I •To be filed with your county treasurer. I•Read instructions on reverse side.
<br /> Name of Organization Type or Ownership
<br /> GRAND ISLAND AREA HABITAT FOR HUMANITY ®Nonprofit Corporation ill Other(specify):
<br /> Name of Owner of Property County Name State Where Incorporated
<br /> HALL NE
<br /> Street or Other Mailing Address Contact Name Phone Number
<br /> 502W SECOND ST Dana_3e,l1 ,-,ec og. - 3f35 _ 55 G
<br /> City State Zip Code Email Address
<br /> GRAND ISLAND NE 68801 GlC-v.ak_Q 0 i Data;i—cJ . G-rcj
<br /> Identify Officers,Directors,or Partners of the Nonprofit Organization
<br /> Title Name,Address,City,State,Zip Code
<br /> -rester.-1t B, •,r,,,,Sci.,,,_i-rz $ la w LSrb. G-= t`3E 6$t'Q I
<br /> v. P. Cix.;r Fnr 3c 4 W. 7 t-�, C-T tU E c 8.3 c(
<br /> `•rcrc Zrt JenniEu 3 n+--; low t1.t.Kt vtr,.c (Lc . (,- Nt= to k?'C 3
<br /> Description of the Motor Vehicles H
<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 /> G M (' if Newly Purchased
<br /> �cri p<<1�- tf 1 GTEci.+cggzC1 cLc74
<br /> vsCGaChwertc5 (qqg E'cjamc1-raL Le,c •1_4gCSifiaLw'700S 34
<br /> 0...onf ten c>.!-a.1 2000 CCkirsn4-rTiler r-ie:4TSEXZ5�NinI1 (33c,
<br /> µ E N t-rns.le.r Zo•ec, Clad- 113 14JbIAri4sZXS30716C01- _
<br /> LI-c Oaf vrt:de Zct3 Zv"hec( {-rc_. ,r.,-
<br /> Exempt Uses of Motor Vehicle: 5:tjx.{I-c-c I4C( Are the motor vehicles used exclusively
<br /> ❑Agricultural and Horticultural Society jEducational EiReligious liCharitable ID Cemetery as indicated?
<br /> Give detailed description of use.including an explanation if multiple use classifications exist: ES LI NO
<br /> Vet/ales li a cclzr.5 Ct.rt vA.Secl {--trr 't'1"t•.vz sec rr L_V.bt S+c."c W cc
<br /> \-Gc`1 S, Cr,1 t.,.....10'
<br /> ,- o5nen f-f SLe-rie)l+ eS c-- C eke,- cH-i C.c.s *t-t iti I- S.4�c:-j— If No,give percentage of exempt use:
<br /> YKC ..0 c AC- c(- c (c,^ 0 1-50_41 iz_c,-1".c.)
<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 decl that I am duly orized to sign this exemption application.
<br /> sign ///�� Jt-tti1I E. D . j
<br /> here k Authorized nfture Title Date 71 i I / i p
<br /> For County Treasurer Recommendation
<br /> 1proval RECEIVED fonts: Pit M e gq.poa-
<br /> ❑Disapprov I DEC q (�Spp �� �'t/�['J
<br /> L 1 1 2J1U 11 Sign re ofCounty urer Date
<br /> WIi1�
<br /> For County Board of Equalization Use Only
<br /> HALL COUNTY
<br /> TREASURERS OFFICE
<br /> Approval GRAND ISLAND,NEBRASIQomments:
<br /> •
<br /> ❑Disapproval
<br /> Q/� (�
<br /> - ,_/ .C."&4 .A-e - ��- j°Z /5;/-
<br /> Au •rized Signatu - Date ,
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 603,185.and 60-3.189
<br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2006 Rev.B-2011
<br /> Please retain a copy for your records.
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