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201.1
<br /> TOB�FILEpWITH Application for Exemption �ORM
<br /> from MotorVehicleTaxes
<br /> YouR COUNTY py Qualifying Nonprofit Organizations �5'�'
<br /> 7REASLIC�ER •Reat!instructions on reverse side
<br /> . . __. _. --- -_.. —_
<br /> - .. ._. _.. _......_._..- —
<br /> ApplicanYs Name County Type ot Ownership
<br /> �"IKST PKESBYTERI_AN CHLTRCI3 ��� ,. � Nanprofil
<br /> Sireet or Other Ma.—... ,_._._.,._ —.. _--... ---- --
<br /> iling Address Gounty Num6or Corporation
<br /> 2103 W �1NNA ST ��
<br /> __...., �..,
<br /> _ _...._. _..--- ❑Qther(specity):
<br /> L�ty-' -" State Zip Code Slale Where Incorporated
<br /> GKAND ISTYAND NE 68803 _ _ I �� -- -
<br /> -- Narne,Address,Cit State Zi -- ^_ - ^-- --
<br /> �IdentiT Officers,Directnrs,or Partners
<br /> _ .- __ __.... —._ _ ,.
<br /> - Gode
<br /> Tdle . _ --- - y, P —._— _._ _ ....
<br /> _Presiden� of. Cor aren ,_Hi��ins_.22Q�,�_che Rd Grar�d.._I�Land...I�IE1z$$_01 __.....
<br /> U.P r e s ... - --.,. _..5��__..�.2 9.�Lermi_t_a�a C�d_._Is].aud. Di E 6_8_8_Q]- -- -
<br /> ...... _
<br /> Re.gis��.r�d._as���r_ e..�nith ��nq �.rza�he-ad.�d. �x�.I�l.axui_.NE.hRRn�_.._ ...
<br /> ��i...f_]�.52��i nn............. �$�1-�n �I7n� .,.�_i.�{�nm�a0��o_..�ro��� .Ts�r7t3� ..�I�-FS2R(l� _-.....
<br /> Attach additional sheet i1 nece
<br /> _
<br /> LI57SPECIFIC p�SCRIP7ION OF7HE MpTORVEHIGLES
<br /> . ssary
<br /> _..._ --- -- --- . -_.._ _ --- — . _..--
<br /> - - - - - Hegistration pate or Date
<br /> Vehicic Make Model Year Botiy Type Venicle Ident�fication Number of Acquisition�i Newly
<br /> Purchased
<br /> ,. .. _.. _ __ _ m
<br /> `, lsaosoo��. ��. . _��or�.���� �axc�9.�5x1.o�_�Q�_ . .. _
<br /> __cr���_� ----
<br /> --Ca�c�mate_. ... . _ �_. . __lb_.'__..�'s�clo�ec�—._....4X4T,Sb1F�vNn71 9'�4.._...- ------ ___ _..
<br /> _
<br /> _^...�'l� . 0�_..._..,_ �x��ian -�T�T�1-�ia��5-4�b��- — .. _
<br /> .. __,. _._
<br /> ---.... �.- --- _ .� --.. .—
<br /> __.. .. --- ----- —_ __.
<br /> Nature oT Use of Motor Vehicle: Are the motor vehicies used
<br /> exclusively a5 Indicaied?
<br /> �AgriculturallHorticultural ❑ Educalional �Religious U Charitable u Cemetery
<br /> Give detailed description of use,including an explanation it multiple classifications exist: . __ �YES ❑NO
<br /> Transportatian of church members on Sunday; youth gr.oup to eve
<br /> reschoo�_ ie.�,��ns• m �_ _.._ _..— _- irN ; � ��tr,�a _�.-
<br /> —._, ' � is:Gion �r�ns;�r �r�at�; me.erG -- _E�z. ���r.���� `
<br /> �-
<br /> for church members and staff.
<br /> � . _ . _. _ __.. _ . D EC � 20'�
<br /> � _..._ _._
<br /> Under penalties vf law,I declare that I have examined ihis application and,to the�est of my kno edge and be6ef�?s;_.c�rrccR aqd
<br /> nomplete.I also declare that I am duly suthorized to sign this exemption applicAtion,and that the organiza on ownir�g�sai'c��Poperty does n4trr
<br /> discYiminate in membership ar employment�ased on race,color,or national origin. ....�, ._„,_„_„ , � °�-'�KH �
<br /> , � -
<br /> sign ��,� - � �,,,��C� iz/s/zozo _
<br /> � ° ,x - -�� -..-
<br /> _.... �� /�'4.�- _...._ .���_ _..
<br /> here ,AutFiorized Signature Tiqe nate
<br /> _ _.
<br /> _..... �_..._.. . _ .....
<br /> FOR CQUNTY7REASlJRER S R�GOMMENDATION
<br /> ,. .� .. _.
<br /> _. _...... -----.. __. _ —.. _ _. _ __.._..�
<br /> % � / � � /'��' J''
<br /> �'APPROVAL CdMMENT5: '? i/�-..../ I. �C._°� _...._.._ ._-
<br /> ❑D15APPROVAL - �- ° --
<br /> �5� �, � � -�!� -/C,�
<br /> l �_._ . . .- --- �-.... -
<br /> t e ot Gounty Treasurer pate
<br /> ... - - _
<br /> �" EQUALIZATIQN USE ONLY
<br /> FAR COUNTY BOARP OF- - -._ __.._ --------.... __.. _.
<br /> �APPROVAL COMMENI'S' — . ... - ----
<br /> []DISAPPWQVAL � � r rl
<br /> ,--- „ - -i( _� --
<br /> / � � / ,,
<br /> � � �
<br /> ` _.—__._._ �,/� , / � _ ,. - Date —
<br /> I Aut rized Signature
<br /> �
<br /> _ _ _ ..... - --- ... .
<br /> 9G-253•2006 Pev.`-200�Supersedes 96-2`3-2006 Authorited by Neh.F7ev.S(at.§77-2U2(1)(r.)(d),§60-3,167§60-3,769
<br /> Nebraska DepartmeN of Gevenue
<br /> � Nev,11-200�
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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