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Nebraska o, I Application for Exemption FORM ����
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations
<br /> cionairenstam
<br /> •To be bled with your county treasurer. 457
<br /> Applicants Name •Read instructions on reverse side.
<br /> Orphan Grain Train, Inc. Type or Ownership Nonprofit
<br /> Street or Other Mating Address
<br /> County ®Nonprofit
<br /> 427 N Shady Bend Road, PO Box 545 Other Hall
<br /> City
<br /> State Zip Code State Where Incorporated ❑Other(specityt;
<br /> Grand Island NE 68802 Nebraska
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> Chairman Dick Ttroester,2110 Topeka Circle,Gland Island,NE 68803 —
<br /> Vice-shaman Gary Mack,555 Stagecoach Rd.,Grand Island,NE 68801
<br /> Secretary Ron Kushner,530 Watson SI.,Blue FM,NE 68920
<br /> Treasurer Pat Benson,65 VRhwbend,Marquette,NE 68564
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> MotarVd4kde Make Model Year Registration Date or
<br /> BodyType Vehicle ID Number Date of Acquisition,
<br /> if N
<br /> Ford 2013 F-250 pickup 1FT7W2ATSDEA39123 Newly 4P 2017sed —
<br /> OMC 2006 truck
<br /> Ford 100J1376F901233 7-1-2015
<br /> 2002 F-350 pickup 1 FTSW30S62EB39517 —
<br /> Mkldefxry 2010 tracer SR ABE1010AM504932 Jan.,
<br /> Sept,2011
<br /> Haulnark 2006 tracer 16HC810146H1419676 —
<br /> Exempt Uses of Motor Vehide: - f3!exrSis
<br /> ❑Agricultural/Horticultural Are the motor vehicles used exclusively —
<br /> ❑Educational ❑Religious ®Ghadtahie ❑Cemetery as Mauled?
<br /> Give detailed description of use,including an a planation if multiple use classifications exist: ®YES ONO
<br /> Used for fundraising activities,delivery of disaster relief,etc.and collection of clothing&medical
<br /> donations to be distributed to those in need. For more information contact Dick Troester 308-380-3730 k No,give percentage of exempt use:
<br /> t6
<br /> Under penalties of law,I declare that I have examined cis application and that it is,to the best of my knowledge and belief,true,complete,and correct.I
<br /> a m declare that lam duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate
<br /> membership or employment based on race,color,or national origin.
<br /> sign la
<br /> /J�
<br /> here Autfwdzed Sign re atu Branch Manager/Chairman 12-10-2018
<br /> The Date
<br /> � ,m FOR COUNTY TREASURER RECOMMEND(ATIIONN�n
<br /> IN6lPPROVAL F.,..--,,;:.1.- --,, MME • F � 055 r- l ea021
<br /> ❑0 DISAPPROVAL Cu
<br /> PET. rt 1ak■111�
<br /> I e4 I/
<br /> - Signature of County Trea er YI\N^`/k • Date
<br /> co;An-FOR COU BOARD OF EQUALIZATION USE ONLY J
<br /> u ERs OFFICE
<br /> ,•✓ISL:;) NEBRASKA
<br /> 61 APPROVAL u S:
<br /> ❑DISAPPROVAL
<br /> 1. /
<br /> ,�Aumon ed signature ` -- ( /i
<br /> Date /
<br /> Nebraska Department of Revenue i
<br /> 96-253-2006 Rat 8-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> Authorized by Neb.Rev.Stet§§]]-202(1lteiaM loft.and 60-3,185,and 603,189
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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