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Zaa.� <br /> 70BEFILEDWI7H Appiication for Exemption �o�M <br /> from MotarVehicleTaxes <br /> YOUR COUNTY by Qualifying Nonprafit Organizations 4,57 <br /> TREASURER •Read insiructions on reverse side <br /> _.. .__ ._ _ _.. - ---.. ... .. <br /> --- <br /> Applicant's Name Cbunty 7ype of Ownership <br /> �r�C�S� OF ��� ZS��D _.. ��L �NonProfil <br /> Street or OYher Mailing Address County Num6er Corporation <br /> 2708 OLD FAIR RD �0 BOX 1531 40 _ __. ❑other(s�ecity�: <br /> _... --- -. <br /> Cjty 5tate Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68$02 NE ---° <br /> _.. _ —_ --- <br /> Identify Oflu,ers,Pirectors,or Pariners <br /> _... --- __. . ._ _.. _. <br /> 7itle I Name,Address City,State,Zip Code <br /> _.,..� _._ ._ _. ..__ <br /> Presi.dent�I3ishop .....__ William �•_.._pendin�ex�....P� Rnx ..1.5-3� _ r_,-�„d..zs�a��-,-.N��RRn�? -- <br /> Vic.e�xe�l.�ent_ _... APV_ �ar1.�Ts�r.pe.�, 7 S 1 7... 'L�e���t..e. .A�--��-�. ..I��,._.�t�..dg_on� <br /> Secy/'Treasurer _ .__ Rev. M%GYL��L�1cD�rmnt-l-.�.._4-1�-Q—Ga��,^„?�^���ra�s�a�d,�a803-- <br /> �. � _. <br /> LIST SPECIFIC DESCFiIP710N OFTME M070R VEHICI.�S <br /> � •Attach additianal sheet if necessary <br /> � _ _.. _ _ . _ .. -- - -- _ <br /> Registration Date or Pa4e <br /> Vehicle Make Model Year Body Type Vehicle IdenUfir.ation Numbcr of Acquisitinn if Newly <br /> � Purchased <br /> -- --.., _...__ ..— _.. <br /> _...�3�nciai Ge_n_esa s _ 2009 . ,_ _ Sedan KMHGC46�.99U04806 April 28, 2009 <br /> _� —._ . . _ _ __ _ <br /> _ _... __� . ._ .. _.. ___ - --. . ._ <br /> _ _. __ . _ --.. <br /> - ------- _.. <br /> Nature oi Use of Motor Vehicic: Are the motor vehicles used <br /> ❑AgricWtural/HorticWtural C]Educational �Religious �Chariiable [�Cemetery <br /> exclusively as indicated? <br /> Give deTailQd description of use,including an explanation if multiple classifications exist: __ nu YFS ��NO <br /> _. _�is_ vehi,�le is_�_used _entierely_for re7 z ious charitable_ aur ose o,g,v _ p � ,� <br /> . <br /> _ _. __. _. _ � �� �����o <br /> -- , i <br /> --- _ I�OV � 2 Z010 <br /> � <br /> � Under penalties af law,1 declare tMat 1 have examined this application and,tn the best of my knowledge nd belief,it is qq�e�t�,e�ry-�-y <br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization o ing said prt�,y,���rqq�p�FIC� <br /> discriminate in membership or employment 6ased on race,color,or national origin, GftAN1�IS1ANp,N�ESRASKA <br /> SIC„�61 Presa.den�/Ba.shop /'//f io <br /> _..... <br /> _ _. __ . �_.....-- <br /> h e re Auth ed Signatur Title date <br /> ---,.._ <br /> FOR COUNTYTREASURER'S RECOMMENDATION <br /> � __ —. ---- --.. _. —.. _ __ <br /> [I.�CPPROVAL COMMEN'('S: _�� ��/ '��� <br /> []DISAPPROVAL — _... _._...._� <br /> n � . <br /> �_ ��__ _ �_-���._ <br /> Signature oi County Treasurer <br /> -- __.... - Date <br /> . � <br /> FQR COUNTY BOAFiD aF EQUALIZATION USE ONLY <br /> �._,._ -- — .._. ---.. ... _....— -- <br /> r]APPROVAL COMMENTS: -- <br /> U D15APPROVAI. � ��- ,` ^,,, . <br /> __ � � ._ — --. <br /> . � r �� � `'. —.. _ .. _� <br /> 'Authorized Signature Date <br /> _. _....----... ..._ —. -- <br /> ��- -�- -�'�� Authorized 6y Neb.Rev.StaL§77-202(1)(c)(d),§60-3,1A5§603,189 <br /> NeUraska Departmant of Fevenuc <br /> 96-253-2�06 Rev.5-200�J Supersedes 96•253-200G Rev.71-2009 <br /> PLEASE MAKE A CdPY FOR YOUR REC�RDS <br />