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E f, 4 )a LA-2t-2!• FilewithYour 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 AMERICAN NATIONAL RED CROSS 2026 �45000 Name of Owner of Property County Name State Where Incorporated AMERICAN NATIONAL RED CROSS HALL NE Street or Other Mailing Address !Contact Name Phone Number 404E 3RD ST TINA LYONS (402)960-9973 City State Zip Code Email Address GRAND ISLAND, NE 68801 'TINA.LYONS@REDCROSS.ORG Typeof '___ __ . . _ ------_----.__ _ _.�_ _ _ ypOwnership: ❑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 ❑✓ 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) RI 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 TINA LYONS FLEET MANAGER 3838 DEWEY AVE OMAHA,NE 68105 —t Description of the Motor Vehicles •Attach an additional sheet,if necessary. Registration Date or I Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition If Newly Purchased RAM PORMASTER 3500(39843) I 2023 HIGHTOP VAN 3C6MRVJG5SE565054 1 1/31/2026 I • • Give a detailed description of the use of the motor vehicle: THESE VEHICLES ARE USED TO TRANSPORT EMPLOYEES AND SUPPLIES TO BLOOD DRIVES. 1 Under penties of law,I dada ,that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. I als declare that I am duly a thorized to sign this exemption application. hSi g erb I/ha '�" FLEET MANAGER 3/24/2026 herb ►Authct.,;,c.d S n: tire ' Title Date For County Treasurer Recommendation . r,g Approval- Comments: EXEMPT-P€-R- t 7-20� - Denial .. MAR 2 2026 kuvrk, D y( 1 (2 Co Signature of unty Treasurer Date _... ..... ............. Wnt t CO+}NTY -. _.. _.. For County Board of Equalization Use Only 1 A Appro 'l i t i,1,ICF A it the County Board's determination is different from the County Treasurer's recommendation,an explanation is required, ❑ Denied I de at to the best of my nowlo e and belief,the determination made by the County Board of Equaliz is correct pi ua tate of Nebraska. n ` qZ1— V✓ Signatur of ounty oa Member Date Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60.3,189 96-253-2006 Rev.8 2024 Supe,sedes 96-253-2006 Rev.7-2024 Please retain a copy for your records.