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20�1
<br /> ToBE�����W�Tw Application for Exemption Fo�M
<br /> vouR cOUNTY from MatorVehicleTaxes
<br /> TREasuR�R by Qualifying Nonprofit Organizations 457
<br /> •Read instructions on reverse side
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<br /> ApplicanYs Name County Type oi Ownership
<br /> GRAY3D ISLAND EVANGELTCAL 1�REE C:HITRCH HAI,L �]Nonprotit
<br /> __...... ......... . .------.------ - --.._..._.
<br /> Street or Other Mailing Address County Number Corporation
<br /> 2609 S BI.,AINE S r 40
<br /> - --- _ ... . _...._ _. ❑Other(specify):
<br /> _._..._. --- ---.._... --- ...
<br /> �jty State Zip Code State Where Incorporated
<br /> cxnrm zs�n �� 6sso1 rr� _ .. --
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<br /> e rs
<br /> 7itle _— _. -- -_..--------
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<br /> Name,Address,City,State,Zip Code
<br /> en i icers i ,
<br /> _.1 ___. . ._. _.__, .
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<br /> ��[l C� ���ct tii:... n�� ���c_c �.,��j�� �.._�~- \o�o�......_ �y:,.���'4�,�_..._�±�C.__C:_�i>�`
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<br /> �syv`'1� �'r c:�S�:.,_v"��f �-+tit�-.., 4�C-tw��r-' —�-`_).� �-C^_v.~v-...•:._v�.L �+.;_ - :C�x v.c� �.-i\.r�...e=..��1..�3�4�.11
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<br /> Attach additional sheet if necessary
<br /> CLES
<br /> -LIST-SPECIFIC DE5CRIP710N OF7HE MOTpR VEHI -- —
<br /> Registration Date or Date
<br /> Vehicle Make Model Year 8ody Type � Vr,hiclr,Identification Number ot Acquisition if Newiy
<br /> Purchased
<br /> -- -._. - ---
<br /> ---- ..
<br /> `�C�i-....._�fJlv\�:•E��GC:L. '_ UQ.4_ Ce - ..t.\',.<: �v�:e�_r.-� _ �-�C��a�'L..L,�.�'$-�� � -- ----
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<br /> ._ _. _._.._. . __. ... ...... .. . ..
<br /> Nalure of Use oi Motor Vehicle: Are the motor vehicles used
<br /> ❑Agricultural/Horticultural � �ducational �Religious ❑Charitable n Cemetery exclusively as indicated?
<br /> Give detailed description of use,including an explanation if multiple classifications exist: �YES U NO
<br /> _.,__,..,. _... ---._,._.__ _...--- If No,give percentage: LC`�-= /
<br /> ��..r�...�c <'�_ -'�= S�. S``-S�'� f-5 � �� ..��c`w--��._��:. o .:C.ti''C 5 — - n:
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<br /> ��`�;� 1 7 2010
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<br /> Llnder penalties of law,I declare that I have examined this apphcation and,to the laest of my knowledge and beliel,it is correct and
<br /> complete.I also declare that 1 am duly authorized to sign this exemption application,and that the organization o ning said property does not
<br /> discriminate in membership ar employment based on race,color,or national origin. Hn.f_L CCJUNTY
<br /> T73c.�tiSl%RE.tZ�pFFICE
<br /> c` c-�� GFtAND ISI,.Af�'L',NE�E3R:;KSA
<br /> sign � � �
<br /> � .rs_--��_'�_ ��-_. �L,..��� \.-5 . \\\� \`-v
<br /> here ��Z�dSign�tture �,� ` Title Date �
<br /> - -=- .. —_ .... _.._ ... _._ . . . _�__�
<br /> � F4R COUN7Y7R�ASURER'S RECOMMENDATION
<br /> �...._._.. __ -----...._... ------
<br /> �PPROVAL GDMMENTS: �..__././���_�L._.���
<br /> []DISAPI'ROVAL _..
<br /> � ���% ��
<br /> � -------_.__...-.___.... -- --._ .,.
<br /> �Signature of County Treasurer Qate
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<br /> FOR COUNTY BOARD OF E�UALIZATION 115E ONLY
<br /> ❑AfaPROVAL COMMEN75: ----------------.. . ..._,
<br /> �DISAPPf�OVAL � -- �f..-- T
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<br /> Aut orized Signature Uate
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<br /> Ne6raska Department vf Revenue Authorized 6y Neh.Rev.Stat.§77-202(1)(c)(d),§60-3,185§60-3,189
<br /> 96-253-2006 Rev.5-2009 Supersedes 96-253-2U06 Rev.1 7-2008
<br /> PLEASE MAKE A COPY FOR YOUR RECORbS
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