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<br /> TO BE�ILEDWITH Application for Exemption FoRM
<br /> from Motar Vehicle Taxes
<br /> YOUR COUNTY by Qualifying Nonprofit Organizations 457
<br /> TREASURER •Read instructions on reverse side
<br /> _. ...—.. _ —.._.-----._.......,... _ __
<br /> Applicant's Name � County Type oi Ownership
<br /> NF:BR ANNUAL CO$�3'FFREY�ICE OF UN1rED METHbllIST Ct�URCH 13AT�, ___ �]Nonprofit
<br /> g . . — --
<br /> Sireet or Other Mailin Address County Number Corporation
<br /> 207 1� P'TNE ST STE 102 „ 4� _.. ❑otner(speci�y):
<br /> P __..
<br /> City State Zi Code State Where Incorporated
<br /> GRAND ISLAND NF 68801 NE __..,. .. ..._
<br /> _. ... —
<br /> Ideniify<�f • -
<br /> ,.- ers
<br /> _�,_ _ .. _. __..... .._.... _.
<br /> . .._ _.... � _
<br /> Title Name Address,City,State,Zip Code
<br /> _ -. _._ , _ .
<br /> icers, ire�ors or ar
<br /> ��'� �� C� x.r��. �n 1���1� . ���. _e �c.. �(a 31.� �
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<br /> �e.cts�Lr��a, __e ohi n K.�1 o r� 33� __I�.�ma�r 1 v _ . ��: n , _ ��c?_
<br /> �.4�.i� ��-.���u�e.S ��t'e.�e���(�, ��Oo �1.�.c.,,rz� .�..�1 ca�in� ..�.�C3.S�-._ . ...--
<br /> _._. .
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<br /> . _. .
<br /> LIST SPECIFIC DESCRIPTION OF 7HE MOTOR VEHICLES
<br /> •Attach additional sheet ii necessary
<br /> Vehicle Id
<br /> _� ._. - --- _.
<br /> _., _. Reyislration Date or Date
<br /> VehiclA PAake Model Year � �ody Type � entifir.ation NumbEr of Acquisition if Newly
<br /> _ _.
<br /> Furchased _
<br /> _....•
<br /> _(__V_1,��:_c,�� Uovka ��`� s_�c� -�_��_D_[����__ --_ d _
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<br /> �;�..... �_\.� ���L__.. .__ �l N��--.CU�1 t�._ �i� 2� aL i i:3
<br /> Natur�of Use oi Motor Vehicle:� Are the molor vehicles used
<br /> �Agricultural/Horiicultural �Educationa! Religious �Charitabie �Cemetery
<br /> exclusively as indicated?
<br /> Give detailc:d description at use,including an explanation if multipte classifications exist: �8���°
<br /> �
<br /> U��-�b �`s-�, c�.''t,��r�ir1�1�r�� �~-o � r.���,� e�.c�'e�s ��--11� �,�,��.�'■�..�
<br /> � It No,give percentage: %
<br /> � �U,��.�'v►s i r-� -��s��� a�.�nd churc�- (uo°l�
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<br /> ' i��a ur cQSrt� ��c_�.1 Gh�� c�e�
<br /> NA!.L CC7LfN1"Y
<br /> TRF_/a4t.;F".��,:i CJFFIC�
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<br /> .. . ..., __... ._..,.... .-,-. ..,_ . . ..
<br /> � Under penalties of law,I declare that I have examined this appiication and,to the best of my knvwledge ' ;•rt-tis'eorrec't'arrii
<br /> complete.I also dec re that I am duly authorized to sign this exemption application,and that the vrganization owning said property does not
<br /> discriminate in me bership or employment based on race,color,or national origin.
<br /> .
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<br /> s�gn � �� .._ � ���_���--.�r�,� _..�a� 11—._��Q1�
<br /> here Authorized Signature Title �ate
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<br /> �.,__. �p�GC'.:tiT:'T�E".�J!?�^'u S'ECO":�"l:C",C,�, ���:
<br /> _..,. _.._. —.-- ..._�
<br /> �,._ __ _._ _..
<br /> (��PPROVAL COMMENTS: �� ���oZ� _. _.......--
<br /> �]DISAPPROVAL —..._. _... ,.. —.—
<br /> .� .,�J ��� '/�
<br /> _ _ _ _ _ _
<br /> Signature vt Gounty trea's'urer ❑ate
<br /> _
<br /> ... . � . .— __.. .__�
<br /> FOR COUNTY BQARD OF EQUALIZA710N
<br /> C__ _ __ _ — --- -. __.— _._...
<br /> C�APPHOVAL COMMEN7S: _ - -..,,....- --... ..
<br /> � ..
<br /> ❑bISAPPROVAL . "� _ " nf - - �� _.,,.._ _.T
<br /> �
<br /> A � `� �: �_ - '�
<br /> - _.__.....__� -.. ' . _.__�
<br /> Authorized Signature � Date
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<br /> � .. _...,. .,.. _�_.._.,...,, Au�....._....
<br /> Nebraska�e drtment oi Revcnue horized by Ne6.Hev,Stat.§77-202(1)(c)�d),§G03,185§EO-3,18�J
<br /> gG•253-2006 F�ev.5-2009 Supersedes 96-253-2006 Rev.71•2008
<br /> PLEASE MAKE A COPY FOR YbUR RECQRDS
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