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REBRA1/423474,- Application for Exemption FORM <br /> Good Life.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> _ •To be filed with your county treasurer. <br /> ^ •T•• T°'•^w• •Read instructions on reverse side. <br /> Name of Organization Type of Ownership <br /> GRAND ISLAND DIVE AND RESCUE TEAM Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property County Name State Were Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Contact Name // Phone Number <br /> 3107 WOODRIDGE BLVD 84f2Cre /( 1a7 '6RA-1 308 - 590- £.94 <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68801 4i eyc,c baczyz6,4a @ G/4/0 , COA4 <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State.Zip Code <br /> PRoraoe r V-v LF. a,4ev,l/Z3 EAle-mentti 4vG2G,eaa /s q.uQ,ueG88J/ <br /> V o T J L- _ -• a' sr$ 2 .1• <br /> 4/was Ave Geatao het-MA .f/ec•eS?Y <br /> a: O e9- t • C l �i <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 /> IAler c Cgzvo 3Z46 6e ct3 L/nun'Tka/cax lUiefirtr rs311a Plo9 S 5?.e <br /> 2003 I-zitR Rcr)l9 <br /> Nature of Use of Motor Vehicle Are the motor vehicles used <br /> ❑AgdculturaVHordcultural ❑Educational ❑Religious ACharitaple ❑Cemetery exclusively as indicated? <br /> Give detailed description of use,induda1g an explanation if multiple classifications exist: RYES ❑NO <br /> T/S Mauer is /lira al m4•/5.422r D/v6 .eeSC4e ` <br /> If No,give percentage: y, <br /> Fleva/ give.& nee Cr..anoc/lev !dread /se aava .e/E TO nevi/f,/a <br /> PFdaren lice/hexer cenRe 61-A2elnReocath Geaab /s&eia AIBY <br /> AGsa Ra• USED Coe u,.o,-&r S'AFe7Y Yfl4ivms dl assr.( ALSa <br /> lv 418O.c1A_ /4l tine A/r- fJ./- h nraar ezca rveasu< - . <br /> Under penalt'=s of . ,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 f. -- /rn' I' •my au .•rized to sign this exemption application. <br /> sign �/r ,: VTr9sevzc /2-2. 20/8 <br /> here - thorized Sg a ure Title Date <br /> For County Treasurer Recommendation � <br /> thApproval RECEIVED Chainlents: &thick W WJSSS 1 t-ace, <br /> ❑Disappro•al <br /> • <br /> DEC 1 ?_ 2018 ._ G .1.. ' - '1..G ('I LORI'S <br /> —rgnature•County Treasurer Date <br /> For -aunty Board of Equalization Use Only <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> Approval GRAND ISLAND,NEBRASK¢nmgents: <br /> ❑Disapproval <br /> a 4-1 /1.---111(- / > <br /> Author'ed Signature Oat. <br /> Nebraska Department of Revenue AuOgrized by Neb.Rev.Stat.§§77-202(1)(c1 and(d).and 60-3,185,and 603,189 <br /> 96-253-2006 Rev.7-2018 Supersedes 96.2582006 Rev.8.2011 <br /> Please retain a copy for your records. <br />