|
�oii
<br /> TOB�FILEDWITH Application for Exemption �ORM
<br /> from Motor Vehicle Taxes
<br /> YOU�t coUNrv by Qualifying Nonprofit Organizations 4,5�
<br /> 7REASUR�R •Read instructions on reverse side
<br /> _. .� _
<br /> County Type ot Ownership
<br /> ApplicanYs Name
<br /> F'IRST CHilRCA O� T�IE NAZARENE ��L �rvonprofit
<br /> —.. _.
<br /> _ _.. . _._
<br /> Street or Other Mailing Address Gounty Number Corporation
<br /> 1��� W 6�H �T �F� L�pther(specify):
<br /> . _ _ _..... ..
<br /> City State Zip Code State Where Incorporated
<br /> GRAiVD IST.AND N� 68801 NE _ - _.
<br /> _ _—. .. _ _..
<br /> Identify Oflicers,�irectors,or Pariners _ __
<br /> _— —_.,
<br /> __ -- - --
<br /> Tdle Name Address Gity,State,Zip Code _ _. _
<br /> _,,.__ _ ...
<br /> _.
<br /> -- — �.--_
<br /> ,����c�ee�.�---- .�'�.�%'z f U i/ c.rJ. b r'�.5'i ��- /�l�;_ . �,�.d/ —
<br /> - r - � �rr�lJ.�� . �./��. �~� ....,,.ic`_-.. .. .��'�-'��J_. .--
<br /> �if'���"��—q:....� ^/-_ ,��=�ZL.__W --
<br /> _.__
<br /> __. _ . .
<br /> ... _.. . _ _
<br /> LIST SPECIFIC DESCRIPTION OFTH�MOTOR VEHICLES
<br /> •Attach additional sheet if necessary _
<br /> - Hegistratia�Uate or�ate
<br /> Vehicle Make - � Model Year � Body Type Vehicle Identifir.ation Numher oi Acqu�sition if Newly
<br /> _ _..,._ _ .
<br /> _
<br /> urc as
<br /> _.
<br /> —.�, ----- —_.
<br /> I-c.r�. --/inL �3. _J�S� Cr�rJ.r� c-��i�? . "i=13J.�.�l���� , -- -/����..
<br /> -- __ _
<br /> - --- - _..
<br /> Are the motor vehicles use
<br /> Nature of Use of Motor Vehicle: _� r� exclusively as indicated?
<br /> ❑Agricultural/Horticullural ❑Educational ��eligious LJ Charitable ❑Cemetery.
<br /> Give detailed description of use,including an explanation if multiple classifications exist: ,
<br /> 0 Y�5 ❑NO
<br /> ■ i�� 41�...:'I?'.
<br /> �TA L-��r`.�—..���_v�.���/�.._._ �_�`!�_. - It N * rc�t an� %
<br /> ,__
<br /> --...���c�.i:.�i. c.�,,.,..!..� . _. -
<br /> .. ._ _ o�c � s zQto
<br /> �
<br /> .� ,� __
<br /> �,,�,._�.��.,�r
<br /> Under penalties of law,I declare that I have examined this application and,to the best of my knowle ge and peli��t�s,�j(�reje��[��10E
<br /> complete.I also declare thet 1 am duly authorized to sign this exemption application,and that the organizatio owning��Fgpe��yndc�s�at;I�eAKSA
<br /> discriminate in membership or employment 6ased on race,color,or national origin.
<br /> �
<br /> S I g 1'1 ' �},���__ �fl���.�. _ ��`��tC�
<br /> ._ . _��. pate
<br /> here Authorized Signature �I Tiue
<br /> � _ _
<br /> _ _.. _ _ _..
<br /> - _. - -.
<br /> FOR COUN7YTREASURER'S RECOMMENDA710N
<br /> ----.. _
<br /> _. _.._
<br /> .y _. _. ... _ ... -- -_ ,___
<br /> � ' � �" ' ��.I.,., ! %'.��_�__ ,.
<br /> LI_�APPROVAL COMMENTS: %+'''._.�� '� ' � —_ _. _._...
<br /> []DISAPPR�VAL / - -"
<br /> --.
<br /> ` ,; ���; ; .+`'' e•-: f, . /.�,;//�'�`�'i
<br /> _..� �. r�•� l _ , .._ _. ,
<br /> Signature of Counry Treasurer Date
<br /> _ ----.—_ _ -
<br /> � FOR COUNTY BOARD OF�QUALIZATION USE ONLY
<br /> ❑APPROVAL COMMENTS: —... ..._ —
<br /> n DISAPPROVAL � � h�R` { ` � J. L
<br /> ry _1''__. . F, ' .... ��-�-
<br /> ' "4 � �� ._.,.
<br /> � ..-.,. ° .... ... �. . -
<br /> Authorized Signature Date
<br /> _. . —.
<br /> —
<br /> NebraSk�DepulllllBnt pf ReVO�uc AUthariz2d 4y Ncb.Hev Std.t.§77-202(1)(c)(d),§60•3,185 6 - , �
<br /> 96-253-2006 Rev.5°2009 Supersedes 96-253-2006 Rev.71-200�
<br /> PL�ASE MAKE A COPY FOR YOUR RECORDS
<br />
|