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NEB- Application for Exemption 2.0i q <br /> Good L•fe,Great Serves. <br /> from Motor Vehicle Taxes by Qualifying Nonprofit Organizations FORM <br /> •,,,a,.a,,,e„ •To be filed with your county treasurer. A 57 <br /> •Read instructions on reverse side. s} <br /> Name of Organization Type of Ownership <br /> Heartland United Way, Inc. ®Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property County Name <br /> Heartland United Way Hall NE State Where Incorporated <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 1441 N Webb RD Karen Rathke <br /> 308-382-2675 <br /> City State Zip Code Email Address <br /> Grand Island NE 68803 karen@heartlandunitedway.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name.Address,City,State,Zip Code <br /> President/CPO Karen Rathke,3838 Meadowlark Cir,Grand Island,NE 68803 <br /> Board Chair Mark Moravec,2804 Kingston Cir,Grand Island,NE 68803 <br /> Board Vice Chair Man Johnson,5 Cougar Ln,St.Paul, NE 68873 <br /> Board Treasurer Wade Jarvi,309 Buffalo Grass,Grand Island,NE 68803 <br /> Description of the Motor Vehicles i <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make Model Year Body TYPa I Vehicle ID Number Registration Date or Date <br /> Mew l Purchased Acquisition, <br /> Ford- 2010 F150 1FTFXZ1CV6AKAg468 <br /> Haulmark 2014 Trailer 575PB1420EH264757 <br /> I <br /> Exempt Uses of Motor Vehicle: r <br /> ❑Agricultural and Horticultural Society QE Are the motor vehices used exclusively <br /> Ie+Y ducetional �Rea'gaus �Charkeble �Cemeery as indicated? <br /> Give detailed description of use,including an explanation if multiple use dassitications exist ®YES ONO <br /> The Ford pickup and Haulmark trailer will be used for United Way programs,fundraisers and <br /> charitable events. Several programs utilize the pickup and trailer to deliver toys,books,food If No.give percentage of exempt use <br /> and household furniture to help people meet their basic needs. The pickup and trailer are % <br /> also used to transport program items to schools,food pantries and community partner <br /> organizations located throughout Hall, Hamilton, Howard and Merrick counties. The vehicles <br /> are also used by staff to travel to local,county and sometimes state United Way functions. <br /> Contact Karen Rathke at 308-382-2675 <br /> Under.-.rallies oi l: re that I have examined this <br /> l also that I amt application. <br /> sign and,b the best of my knowledge and belie[it is correct and corn e. <br /> sign i ,•iw_'1.1:.to sign this exemption aprtiiratbn.• <br /> here • :� lt.fl ' ,( President/Chief Professional Officer 12-04-2018 <br /> re Trite <br /> Date <br /> For County Tre asurer Recommendation <br /> 3pprovai RECEI Y EDcomme ts: 4'1'10- e3L N54 7 r l e C° <br /> ❑Disappro <br /> DEC 7 2018 (t��y��L rondo <br /> I'Signature of County T el r Date <br /> N"Lt 6^tNTY For C unty Board of Equalization Use Only <br /> GRAND ISLAND,NEBRASKKAp <br /> Approval Lamm:its its: <br /> • ❑Disapproval <br /> )7/ ,. <br /> • Sigma ure / <br /> Date <br /> • Nebraska Department of Revenue f <br /> 9B-2632006 Rev.�2018tiuperaapaeg6.253-2006 Rev.8-2011 <br /> Authorized by Neb.Rev.S .s§77-202(19c)and f�,and 60-3,+85,and 603,189 <br /> Please retain a copy for your records. <br />