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<br /> TO BE FILEDWITH Application for Exemption �oRM
<br /> YOUR COUN7Y frpm MotorVehicleTaxes
<br /> TFi�ASURER by Glualifying Nonprofit Organizations 457
<br /> •Read instructions on reverse side
<br /> -- -._.. _.._..-- — .... ..... __.._._-. . ._ _..._... —
<br /> Applicants Name County Type of Ownership
<br /> BET�LL BAPTIST CHURCH ��� �Nonprofit
<br /> _.._.... . ._... --- _.
<br /> Street or Other Mailing Address County Number Corporation
<br /> 1223 E 6TH ST PO BOX 732 40
<br /> __...... __ _... ..._, .,,. ....._._ _ L]Other(specify):
<br /> _.... -------
<br /> Giry State Zip Code State Where Incorporated
<br /> GItAND ISLAND N�. 68$02 N� - -_ --------
<br /> - -..
<br /> _.- Y P -.
<br /> Identify�fficers Directors,or Partners G-�___��r� �`��
<br /> -- � W _�. _` ---- _.
<br /> 1"itle Name Address Cit,State Zi Code
<br /> — --- -----
<br /> --- -- - �
<br /> ���s, ,� �+�� � s,� � .��� ���y X� _.�<� r���7.�.�� N� � ��.���
<br /> _.. __..._ _.._.
<br /> `- � tc�/ ' � c�ry t' r.! ���/ (��i N:0 i �v=�
<br /> ,�`'. c' � �/"G1]. S � ,..N' t . %h_ _._. t, , � - ��E'. f"�._(�t" �=. r ��._ ....
<br /> _. _... __.
<br /> LIST SPECIFIC DESCRIPTION OFTHE MOTOR VEHICLES
<br /> •Attach additional sheet if necessary
<br /> --------..._.... .
<br /> _... _.__._... _....... . _
<br /> ���� � Registration Date or Qa�e
<br /> Vehicle Make Mvdel Year Body Type Vchicle IdentiFir,atinn Nurnber oi Acquisition if Newly
<br /> ................ ..... .._.. ......._._.._.... . . ..
<br /> PurCh�sed
<br /> . ..__..._ _ . . . _...
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<br /> f�� _ f ;'� ' �7 �"ri rx ' �.'_. '� � �N. h��"R��I��l `��� _
<br /> �..---��-� f`',`1._._.
<br /> Nature of Use o .. ----_......_.- -----------------.__... __. .----...
<br /> t Motor Vehicle: Are the motor vehicles used
<br /> n Agricultural/Horticultural U Educational Religious ❑Charilable n Cemetery
<br /> exclusively as indicated7
<br /> � �
<br /> Give detailed description of use,including an explanation if multiple classifications exist: �/-/1./1�5'/�.+;')'A.f.c'!L+ : �:�a:
<br /> - -
<br /> . � ..,����
<br /> ���t,�r.t� 1�} �77l��� ff�4 I"hr�n. 1�?r.'r•S �v ,L �r�:�- C.�'ac�,;^_�.� ...�..._....__ _ M.�t
<br /> It No,grve percentage: %
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<br /> L�t~�`5 �"��t-r�._._��: s�,` �tr°,l?S
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<br /> _ _. __,_...._. ...._......_..
<br /> F'^�1.�C011r3'rY
<br /> ;LEf�.S O�-FIPE
<br /> —...,,...,..- -----.,...... ,.._.--
<br /> .-. ..., .,-.-.��.�;
<br /> Under penaltiea of law,I declare that 1 have examined this application and,to the best of my knowledg�aqd-pelief;it is correo�
<br /> camplete,I also declare that I am duly authorized to sign this exemption application,and that the organization owning s�id property does not
<br /> discriminate i em rship or employment 6ased on race,color,or national origin.
<br /> s i 9 rt _ /�/.��. �, �,��-� '
<br /> �- -----_. ..._ ._ � _. _
<br /> he�"e IAuiFiorizedSignaTUre `" Title Date
<br /> ---..
<br /> � FOFt COUN7Y7R�ASURER'S RECOMMENDATION
<br /> _.__.. ---... . . .. ------ -- ..... ._.. . _._... -- --
<br /> ��RL'�in,i ----- �nn.4ME�1T5: __.�'1 /!/�� / � e�va__� _—
<br /> U DISAPPRPVAL -_-._---_.__
<br /> � �� "�lv �!�
<br /> - --------
<br /> �Signa ure oi County Treasurer Date
<br /> -- --.. ---------...
<br /> FOR COUNTY BOARD OF E�UALIZATION USE ONLY
<br /> - ._.. _-... _. _. -..... . __.._ .. _....... ..._.- - ----- __.. ---..
<br /> r]APPROVAL COMMENTS:
<br /> []�ISAPPR�VAL �' � -�. ( J , �
<br /> _. .._ __ ._ .... _._...
<br /> r � �
<br /> � � �f�y _
<br /> ----- _ ._ ---- --
<br /> Aul rized Signature D�te
<br /> Nebraska be artment of Revcnue Authorized by Neb.Rev,Slat.
<br /> P §77-202(7)(c)(d),§60-3,785§6�-3,189
<br /> 96-253-2006 I�ev.5-2UD�J Supersedos 96-253-2006 Rev.11-2008
<br /> PLEASE MAKE A COPY FOR YOUR REGQRDS
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