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File with Your Application for Exemption FORM County Treasurer from Motor Vehicle Taxes by Qualifying Organizations 457 •Read instructions on reverse side. Name of Organization Tax Year Value of Motor Vehicles Grand Island Area Habitat for Humanity 2026 Name of Owner of Property County Name State Where Incorporated Grand Island Area Habitat for Humanity Hall NE Street or Other Mailing Address Contact Name Phone Number 502 W 2nd St Lindsey Jurgens (308) 385-5510 City State Zip Code Email Address Grand Island NE 68801 lindsey@gihabitat.org Type of Ownership: ❑Agricultural and Horticultural Society ❑ Educational ❑ Religious ❑✓ Charitable ❑ Cemetery ❑ For-profit Nursing Facilities Charitable Organizations:Motor Vehicle described above is used in the following exempt category(please mark the applicable boxes): ❑ Agricultural and Horticultural Society ❑ Educational ❑ Religious ❑r Charitable ❑ Cemetery Charitable and For-Profit Organizations,please answer the following: If No,give percentage of exempt use: Are the motor vehicles used exclusively as indicated?(see instructions) ® YES ❑ NO For-profit Nursing/Assisting Living Facilities,please select the applicable box: What percentage of occupied beds have been provided to ❑ Nursing Facility Skilled Nursing Facility ❑Assisted-Living Facility medicaid beneficiaries over the most recent three-year period? Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Lindsey Jurgens Executive Director 502 W 2nd St,Grand Island,NE 68801 Claire Nelson President 502 W 2nd St,Grand Island,NE 68801 Lindsay Avila Vice President 502 W 2nd St,Grand Island,NE 68801 Description of the Motor Vehicles •Attach an additional sheet,If necessary. Reggistration Date or Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition if Newly Purchased GMC 2008 ‘,% 1500 1GTEC14C98Z901074 7/1/2025 Ford 2015 ✓ Econoline E350 1FDWE3FS5FDA21476 7/1/2025 Give a detailed description of the use of the motor vehicle: Transportation related to construction and maintenance of housing projects. Under p- = ies 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. I also d- that I-.• oul authoriz ign this exemption application. sign ' , ` 410 \\ C.C3 \) (' ‘ 11 232° here 'Author' •d Signature Title Date r Coun reasurer Recommendation pproval Comments: EXEMPT PER NSS#77 2O. (ifykaj ❑ Denial pee), 2Iiw Vale Signature of County Treasurer Date For County Board of Equalization Use Only XApproved If the County Board's determination is different from the County Treasurer's recommendation,an explanation is required. ❑ Denied I declare that to the%e of m knowledge and belief,the determination made by the County Board of Efel. ',1,on is corr t rsu o the laws f the State of Nebraska. Sig y Bo d Member �— Date Rev.7-2024 Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 Please retain a copy for your records.