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NEBRA-s-KA- Application for Exemption FORM <br /> Goxofe.Greet Service from Motor VehicleTaxes by Qualifying Nonprofit Organizations C <br /> °• •To be filed with your county treasurer. 457 <br /> DF °,,u°*o•°••E°„E 1 •Read instructions on reverse side. <br /> Name at Organization Type of Ownership <br /> HALL COUNTY C/O SENIOR CITIZENS INDUSTRIES INC ©Nonprofit Corporation ❑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 /> 304 E THIRD ST {ll exts4�nc�rWYXCI(- 3c53--S26-- S302 <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68801 t', et11{t? c.44 s C f2M <br /> Identify Officers,Directors,or Partners of the'tNonprofit Organization <br /> Ttle Name,Address,City,State,Zip Code <br /> 1 <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 /> (liCia CS e. :Quip 11V'ClAttCeir ayr ' Os-1k i S D x4r3 R.1q cis 7-1-1f <br /> Exempt Uses 01 Motor Vehicle: Nit Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society []Educational ❑Religious aV Charitable Cemetery as indicated? <br /> Give detailed description of use,including ann explanation if multiple use�classifMications epxiisst: t.. meals 111 'ES Li NO <br /> -1---\-,-i:, VCS Is Lisca `o aeLiuer Yto1ne et-eXtuere( meals If No,give percentage of exempt use: <br /> -br .{.he 6a..et\L , Cur-enAti , c•boLLI- ( S meals are <br /> ctai∎i erni it) home boa ird Sen,.or-s I n kst%( C4)Lcn.4-1-( <br /> ±JJ ekn k - Q i4ery s 16r the Sentf. <br /> Ctan [s �s� USA -b � � � <br /> Under penalties of law,I d&fare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> I alsodeclare tthatI am duly authorized Ign thisexemption application. <br /> e � se� rn di I lr at %—I j J <br /> he , ,' }iture° "f4 Tia, Date <br /> 1 For County Treasurer Recommendation <br /> aApproval Comm...,ts. c$1414- <br /> . f NS' "fi 1- oio <br /> v, 2- <br /> :it im t�' h <br /> ❑Disapproval '""”" °as <br /> u it-' 7018 ►�l ...it d..�. 'fix►i i I.I,Id.. I /rl bei <br /> Signature of j.unty Treasurer 4 Date <br /> For County 3oard of Equalization Use Only <br /> HALL COUNTY <br /> TREASURERS OCFICE <br /> SApproval GRAND,SLAND,Nl P191SRts: i Disapproval a". /�- 4- (.� C 7J �-._ <br /> thoriz..d Signature Date <br /> i <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat§§77-202111(c)and(d),and 60.3.1a5,and 60-3,189 <br /> 96-2534006 Rev.74018 Supersedes 96253.2006 Rev.8-2011 <br /> Please retain a copy for your records. <br />