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NEapA c i Application for Exemption FORM <br /> Go o°Life.Great Service from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> ----no,..E •To be tiled with your county treasurer. A 57 <br /> •Read instructions on reverse side. � Y'J <br /> Name of Organization _._.. <br /> Type of Ownership <br /> OVERLAND TRAILS COUNCIL-BOY SCOUTS ®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 /> 2808 O'FLANNAGAN ST PO BOX 1361 Loner_O'Fn er 5C) -3,32.--9-1 t <br /> City State Zip Code Email Address <br /> GRAND ISLAND NE 68802 <br /> Ilig0 •Gbriers.,' •• <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State.Zip Drip <br /> Pre,taea- Tm, kxet>hhi LOOw.b� }. 14O ttn NF Ln$9�11 <br /> Seo ra- trV 'Nov c1 +}irnr{ 1519 W 11ty islon aolnci S'ltand , I\I E iotriWn,I <br /> T o oacrey- -.On \fonrd ernl'.K, Lit 1 k Ivhe Lrap.n PtU4 kr cc T-S1 c.nc!.Nc L05:>%G� <br /> r <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make Model Year Registration Date or <br /> Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> 0i tmle4- 2211 P;eki-tR 1ROA KY.f fn1p1�F1RYi5Ie to—ri-I' <br /> ce • isto_r TE V I•#.1 • <br /> .2; as r _ �7T.7T•iliQ''• a. b*iiii jti•t�'_ t . • Una <br /> 'pt U ..•. ... . �� of MWD.1 I�QO the r <br /> Exempt Uses of Motor Vehicle: <br /> Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society DZEducational Religious as indicated? <br /> ❑ 5 ❑Charitable ❑Cemetery <br /> MINIIMNISMOMOIMMISpise,including an explanation if multiple use classifications exist: YES ❑NO <br /> Li_SeC1,_ a . @an- p /kirk'nit— for- Cut §na 1 use_ <br /> u- `n � D JJ n Oc Scad he No,give percentage of exempt use: <br /> Garn� <br /> 0cn$) service yoU�-1v to Lk coon- e> in, Cel <br /> a t39s-4en ( )Gbira.Skc\_, F°r JQ5 tx in cam' kJ <br /> Gera or9 ocuu w ;rh -.c'.5 amt• kid s a y6W <br /> Under penalties' aw, r:that I hay- - . .•t .- -xemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> sign I also declare that) .. . .,gn this exem• application. <br /> / +' i aL I `/ <br /> here Authorized Signatu= Title if F pCi LT1 4 1 e i R <br /> Title Date J- <br /> per- °' 3c"� CountyTreasurer Recommendation J <br /> 1 tt...ismi -if ILy y py� • � <br /> Approval Comments: t)C ff tvsc - 11-era <br /> ❑Disapproval L'L'� i C /018 <br /> HALL COUNTY . Zia) 1y/fC��l//f t ttlbtL ti I t/i4ig <br /> TREASURERS OFFICE /Sgnature of Cou Treasurer .. 1 JJJ Date <br /> OR/"D:5L4ra 14C�t�,� �to <br /> �,( �el'1u•drevard of Equalization Use Only <br /> Lyl Approval Comments: <br /> J❑`-Disapproval - <br /> 1, Auth• ized Signatu • Dr <br /> { / <br /> Nebraska Depanment of Revenue <br /> Authorized by Neb.Rev.Stet.§§77-202(1)(c) <br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2006 Rev.8.2011 and(0).and 60-3.185,and 60.3,te9 <br /> Please retain a copy for your records. <br />