DocuSign Envelope ID: 39C14A36-747B-40C0-A57E-222EC8D2C574 NE Dodge 2012 Henry Schultz, 5240 La Salle, Lincoln, NE 68516 Secretary 2C4RDGDG9CR179242 2018 Van Passenger 402-474-6890 Dodge 68430 Bill Cummins, 9620 South 30th St., Lincoln, NE 68516 January Keith Plummer NE 1050 Saltillo Road Potentate 2011 Roca Participate in parades, promote Shriners Hospitals and Shrine activities, transport Shrine patients and their families to Shriners Hospitals for Children. Dodge 2016 2018 January 2D4RN5DG2BR6296719 January Sesostris Shrine Holding Company Treasurer Dd Wagon Dodge X 2C4RDGBG4JR180234 Lancaster January 2C4RDGCG0GR354484 Wagon Wagon Van Passenger [email protected]Dodge January 2C4RDGBG2JR134319 Richard Eggerling, 5554 Chancery Rd., Lincoln, NE 68521
13
Embed
· Dodge 2011 Wagon 2D4RN5DG2BR6296719 2542 Hospital-Columbus 29955 ... Chrysler 2010 town/Country 2A4RR5D16AR137474 2548 Silver General 27893 DocuSign Envelope ID:...
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Henry Schultz, 5240 La Salle, Lincoln, NE 68516Secretary
2C4RDGDG9CR179242
2018 Van Passenger
402-474-6890
Dodge
68430
Bill Cummins, 9620 South 30th St., Lincoln, NE 68516
January
Keith Plummer
NE
1050 Saltillo Road
Potentate
2011
Roca
Participate in parades, promote Shriners Hospitals and Shrine activities, transport Shrine patients and their families to Shriners Hospitals for Children.
Richard Eggerling, 5554 Chancery Rd., Lincoln, NE 68521
Hospital Vehicle Listing
Vehicle Make Model Year Body Type Vehicle ID License # Name ValueDodge 2011 Wagon 2D4RN5DG2BR6296719 2542 Hospital-Columbus 29955Dodge 2012 Wagon 2C4RDGDG9CR179242 2543 Hospital-Charcoal 25750Dodge 2018 Van Passenger 2C4RDGBG4JR180234 2204 Hospital-Norfolk 28937Dodge 2018 Van Passenger 2C4RDGBG2JR134319 2205 Hospital-Granite 28437
Vehicle Make Model Year Body Type Vehicle Id License # Name ValueDodge 2016 Wagon 2C4RDGCG0GR354484 2544 Charcoal 26945Dodge PU 1976 Pick Up D14BE6S254436 2545 Keystone Kops 0Chevrolet 2003 Dr Ext Cab 2GCEC19T0311803 2546 Gray General 12995Chrysler 2010 town/Country 2A4RR5D16AR137474 2548 Silver General 27893
Vehicle is used for AdventSource business purposes only. This would include transportation of employees, officers and board members to and from Lincoln and Omaha airports, the running of business related errands and transport of employees to and from company related functions, conventions and events.
Provide education presentations, training and information to the public in regards to Alzheimer's disease and other forms of demetia. Also used to get staff and items to and from fundraising events for the Alzheimer's Association.
Description of the Motor Vehicles•Attach an additional sheet, if necessary.
Motor Vehicle Make
Thr,W(^
Model Year
2004'
Body Type
i3L(^
Vehicle ID Number
I T'7y74^2SM;fcfc^37
Exempt Uses of Motor Vehicle:
Q Agricultural and Horticultural Society [^Educational |_| Religious Q Charitable [-] Cemetery
Give detailed description of use, including an explanation if multiple use classifications exist:
TnoiSpr?n o(- chi^^n d^ ^^oo/ ^ ^Iwol fic^Vihes
,^>.
^. .^
Registration Date orDate of Acquisition,if Newly Purchased
i-2-2mcj
Are the motor vehicles used exclusivelyas Indicated?
[YES Q NO
If No, give percentage of exempt use:
.%
Underpenalties of laWr+d^clare (hat I hfive examined this exemption application and, to the best of my knowledge and belief, it is correct and complete., l(a|^o declare fjiat I am [duly a^thorj^pdji^ign this exemption application.signj^^lam^tho^^exemptionapplication-
here ^ Authorized Signature L-/^C'hv'^S ^P^'-^rT/-
Titlei-IO-U;^
Date
For County Treasurer Recommendation
{^Approval
Q Disapproval
Comments:
-^?-/^
Date
For County Board of Equalization Use Only
Q Approval
Q Disapproval
Comments:
> Authorized Signature Date
Nebraska Department of Revenue96-253-2006 Rev. 7-2018 Supersedes 96-253-2006 Rev. 8-2011
Authorized by Neb. Rev. Slat. §§ 77-202(1)(c) and (d), and 60-3,185, and 60-3,189
Please retain a copy for your records.
\LEBRA&KA-|3ood Life. Great Service.
;HUE
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•To be filed with your county treasurer.• Read instructions on reverse side.
Identify Officers, Directors, or Partners of the Nonprofit OrganizationTitle
Topher Hansen
Tami Lewis-Ahrendt
Pat Meyer
Name, Address, City, State, Zip Code
CEO 2633 P Street, Lincoln, NE 68503
COO 2633 P Street, Lincoln, NE 68503
CFO 2633 P Street, Lincoln, NE 68503
Description of the Motor Vehicles•Attach an additional sheet, if necessary.
Motor Vehicle Make
See Attached Document
Model Year Body Type Vehicle ID Number
Exempt Uses of Motor Vehicle:
Q Agricultural and Horticultural Society |_] Educational Q Religious |^| Charitable || Cemetery
Give detailed description of use, including an explanation if multiple use classifications exist:
Transportation for clients to AppointmentsTransportation of goods to program locationsMaintenance
Registration Date orDate of Acquisition,if Newly Purchased
Are the motor vehicles used exclusivelyas indicated?
g] YES Q NO
If No, give percentage of exempt use:
.%
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 glsq.declare t)iat I am^ufy aythsrizeiiKp sign this e^em^ion application.
S19n ^f\A?Jr (k ^ {^X^\2W\ _ Director of Administrative Services \-~<§"'ZQ 1 c\here ^ Y Title Date
For County Treasurer Recommendation
.Approval
D Disapproval
Comments:
'̂^^L ^L ,'-23-^,Signature of County Treasurer Date
For County Board of Equalization Use Only
Approval
D Disapproval
Comments:
> Authorized Signature Date
Nebraska Department of Revenue96-253-2006 RBV. 7-201 S Supersedes 96-2S3-2006 Rev. 8-2011
Authorized by Neb. Rev. Stal. §§ 77-202(1)(c) and (d), and 60-3,185, and 60-3,189
Please retain a copy for your records.
^\-)
Make Model Year Color License Plate VI N FacilityLancaster County