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02 02 9 <br /> NEBRAG-Kk. Application for Exemption FORM <br /> Good Life.Great service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •Ni Df aesw,s 'To be flied with your county treasurer. 457 <br /> •Read instructions on reverse side. <br /> Name of Organization Type of Ownership 5O 1 �C <br /> Voice- Por Cairn panl on Rn;mal5 Nonprofit Corporation ❑Other(specify): �3 <br /> Name of Owner of Property County Name State Where Incorporated <br /> Sa„ne� 1-lall AI <br /> Street or Other Mailing Address Contact Name Phone Number <br /> Po (3ox 5x56 P obyn mays 3c8-391- !39L <br /> City State Zip Code Email Address <br /> Grand island kJE eiS` drmay5 rs6ka &,,vnaj'/. co, , <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State.Zip Code <br /> Prtadm+ Robyn mays in 5hrnzxod Qd Grand Jetand Ajt toS303 <br /> Vice Preoidee& Sat 14an'an 3110 Codes tit Gran TSfand eVE 492K0 3 <br /> 5ecr-}e t.lanc Rod. rs t io Ala 5t Gran• isle nd NE -SS's - <br /> aQar. er,-,bier Emily acr•o 1411 Mill 6 ICtnnebr- N6 X8$31 <br /> Soard Member- bonod iliac-1S .oi11 5kenconcl gd Grand tsbnd NE C&c:as <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 Dare of Acquisition, <br /> N Newly Purchased <br /> Ford a008 E- 350 cargo van IFT5534La SOP bosa7 _ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ['Educational 9 Religious Eig Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: p YES ❑NO <br /> used -f=c, deliver pet coca a- Supp11eS tp 7zr.ierS'veterans <br /> 7 If No,give percentage of exempt use: <br /> Pct L'p c n o)t 1 OnS r .e pot coo_ o , c S f % <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> I also declare that i am duly authorized to sign this exemption application. <br /> sign l�o��-tin > 2. Make) P- D� , IQ- ra -I�, <br /> here ,Authorized Sig lure Title Date <br /> For County Treasurer Recommendation <br /> f. �T <br /> Approval RECEIVED Comments: 1)14-441:4- per hiss 44 Ti. aDa <br /> ❑Disapproval <br /> 2 ?018 <br /> DEC - - uliTrctisu�rr.�' hRPR/%8 <br /> /Signature of ny Treasurer Date <br /> HALL COUNTY For C ounty Board of Equalization Use Only <br /> TEHSuRCI(5 OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> Approval Comments: e <br /> ❑Disapproval \ <br /> • <br /> Author ••Signatu•__ - Oates <br /> Nebraska Department of Revenue Authorized by Neb.Rey Stat.§§77-202(1)(c)and Id),and 60-3,185.and 60-3,189 <br /> 98453.2006 Rev.7.2018 Supersedes 96-253-2006 Rev.13-2011 <br /> Please retain a copy for your records. <br />