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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 i Tax Year Value of Motor Vehicles Willow Rising, Inc 2026 A 1a,C0C) , Name of Owner of Property County Name State Where Incorporated Hall County Nebraska f Street or Other Mailing Address Contact Name Phone Number 2251 N Webb Road Hallie Razo r' (308)382-8250 City /. State Zip Code Email Address Grand Island, NE 68803 hrazo@willowrising.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 i❑ 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 • Hallie Razo Interim Executive Director 'dDir3 1 liti . ,U . cSic", 6 sLcd c_f 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 if Newly Purchaser Ford 2014 4 Door Sedan-Titanium 3FA6POD91ER202390 5/17/2017 Dodge 2009 Caravan 1D8HN44E59B507822 12/14/2023 / Give a detailed description of the use of the motor vehicle: These vehicles are used for agency purposes only. They are used for team members to provide transportation for survivors, to trainings/meetings, and other related agency travel. 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. I also declare t t I am duly authori d to sign this exemption application. sign /:, , _'/' � , '�J/ r / Title ,61 E1,-PCI�CP �/ oi4{�C`k Date - ato here Auth iz ig tufe { RECE VED For bounty Treasurer Recommendation C:.i7;n IT PER 2'eLL 4c77-2u2 17.royal Comme its: r Denial FEB 1 3 2026 /e!-z. - ' HALL COUNTY at-zi�,N'1 aPl/q/C9& TREASURERS OFFICE GRAND ISLAND.NEBRASfCA ,Signature of County Treasur Date For County Board of Equalization Use Only 9tApproved If the County Board's determination is different from the County Treasurer's recommendation,an explanation is required. ❑ Denied I declare that to the b- t of kno edge and belief,the determination made by the County Board of Equali ' n is corre p,rs . t to he State of Nebrasskka. /Sign t re o ou .:rd em r v ! I Date zI 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.