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Application for Exemption FORM Good Life.Great Service, from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 •To be filed with your county treasurer. vc•N`"•N,„•..•ENUE •Read instructions on reverse side. I Name of Organization - Type of Ownership - ORPHANGRAINTRAIN ®Nonprofit Corporation ❑Other(specify): Name of Owner of Property County Name State Where Incorporated HALL NE Street or Other Mailing Address ct Name Phone Number 427 N SHADY BEND RD PO BOX 545 t r I i )[p rJtc r 36 g 310 13736 City State Zip Code mail Address GRAND ISLAND NE 68802 ( e o s-±, 1vo K, Identify Officers,Directors,or Partners of the Nonprofit Organization Title Name,Address,City,State,Zip Code Description of the Motor Vehicles •Attach an additional sheet,if necessary. Registration Date or Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, .�..1 �' _ if Newly Purchased 11 Efj U l$ s.tlek-Y J EL'Tc 3 IN 56 ilk, fZ Li !7 rf 44-3 ;rh1C. t c k t> _ SC/2rl5cz4-1 g73. 7-7-I' Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively ❑Agricultural and Horticultural Society ❑Educational ❑Religious ❑Charitable ❑Cemetery as indicated? Give detailed description of use,including an explanation if multiple use classi/ications exist: OYES ❑NO If No,give percentage of exempt use: Under penalties of law,I declare that I have examined this exemption application end,to the best of my knowledge and belief,it is correct and complete. I also declare that l am duly authorized to sign this exemption application. sign here Authorized Signature Title Date For County Treasurer Recommendation Approval Comments: ❑Disapproval Signature of County Treasurer Date For County Board of Equalization Use Only Approval Comments: ❑Disapproval Auth•rized Signatur- Date Nebraska Department of Revenue Authorized by Nab Rev.Slat.§§77-202(111c1 and(d),and 603,185,and 603189 96-253-2006 Rev.7-2018 Supersedes 96-253•2006 Rev.8-2011 Please retain a copy for your records.