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<br /> TOBEFILEDWITH Application for Exemption FoaM
<br /> from Motor Vehicle Taxes
<br /> voUR CouN7v qy qualifying Nvnprofit Organizations (�5'7
<br /> TREASURER •Read instructions on reverse side
<br /> - ............ .. .. . .. ._ _... _. _......_ _______
<br /> °—���p County Type of Dwnership
<br /> Applicants Name ����f�'y�
<br /> ' I ASSE["LT3LY OF GOD ��L __,.___ �Nvnprotit
<br /> —...—_.......
<br /> _. _.,_.
<br /> Stre or Other Mai ing Address County Number Corporation
<br /> 30Z5 INDEY�.DTDENCE AVE �FA _. ❑other(specity):
<br /> .._ ._,._. _. .
<br /> City � State Zip Code State Where Incorporaced
<br /> GRAI�TD ISLAND JNE 68803 N� . ---
<br /> — �, ..
<br /> _..� _ --
<br /> Identify Offic,orG,Duectors,or Partners
<br /> • _ - -. ,. _..
<br /> — �, __ — _ _.
<br /> 7itle me,Address,Gity Sl�ta,Zip Code
<br /> — — _. __ ___.
<br /> ��_ - M.��K
<br /> � ��� "���_ D�E wvoh �vE�_��-ul._��.�'F� -----
<br /> �C - _ — _ '�?.f�Al��L61..5 5 ALz7�1� ' ��?��� �'�_ _
<br /> ► �f�r
<br /> �`Q E�FSU �"�"�u D,�4'�-- 750. i�k !E .. �u�aeg� NE G' �.8"1�_ ..
<br /> � __.._ � --- �
<br /> .. _ _ . �
<br /> LI57 SPECIFIC DESCRIPTION OFTHE MOTOR VEHICI�ES
<br /> Attach additional sheet if necessary
<br /> _.. -- --- --
<br /> �• --- - •- l '"- Reyistrat�on�ate or Date
<br /> Vehide Make Model Year I [3ody Type Vehicle Identification Number oi Ac-uisition if Newly
<br /> f,3 Purchased _______
<br /> _.. ., ^-
<br /> 2 v 8� ��' ,455�r� ) Q�"s3��28��... ._��� _....
<br /> �"D�..�_� -
<br /> �C�-� .... �_�� _.._(r�sr'UG�'rs- v _... I Fa,, �KB --/o
<br /> A ricultural/Hort . - . _ J _._ _,.... _...
<br /> Nature of Use of Motor Vehicle: Are the motor vehicles used
<br /> ❑ exclusively as indicated?
<br /> g Icultural �Fducational eligious �Charitable �Cemetery
<br /> Give detailed description vf usc,including an explanation if multiple classifications exist: �5 �NO
<br /> � �.�C�l��fve' PGVr�L^ `� �"A�i.J If No,9ive���F�� e
<br /> �,R�. �C�[C�l au S �'V�� � ���l-� ��S
<br /> ,
<br /> NO',l 1 8 2010
<br /> �� � Under penalties of law,I declare that I have examined this application and,to the best of my knowledge nd 6elief,it�eorre�ci-����
<br /> comptete.I also declare that I am duly authvrized to sign this exemption application,and that the organization ow in said�ro,per#y�{�e,��at"t�����hSA
<br /> discriminate in membership or employment based on race,color,or national origin.
<br /> sign�i�,,�. � �,,�e�c,�?� __ �� �c��'_.__ `l_�fd^/a
<br /> here �thorized Signature Title p�t�
<br /> FOR COUNTY7REASURER'$ „ T �H ---�
<br /> �" � � RECOMMENI�ATION
<br /> _ ._ ...- --..._ _.
<br /> [rPPROVAL COMMENTS: ��!!.���.a�02=�.. __ __..
<br /> ❑DISAPPROVAL —. .. _... _ __. ,... _
<br /> � ��
<br /> � , jj—/��
<br /> i ture of County reas rer Da��
<br /> _.,. _, _
<br /> _..
<br /> FOR COUN7Y BOARD OF EQUALIZATION USE QNLY
<br /> �.-.,. . ._ _.._ _..,__ _ _ ... _,.
<br /> [�APPROVAL COMMEN7S: _. __...,.. _..... ._._.
<br /> i
<br /> �D15AI'PROVAI� ' �,r - �� ' ---- . .
<br /> -- � ' /
<br /> _ , r" n ��� ( ; �
<br /> � f -- _ __mm
<br /> I Authorized Signature w �^ / pate
<br /> �
<br /> -... , f....'�_ ....... ..._ ... � Authorized b Ne4.Rev.Si2�.. ... , —
<br /> Nabraska Departmenl of F7evenue y L§77-202(1)(c)(d),§60-3,185§60-3,1F3�3
<br /> 96-253-2006 Rev.5-2009 Supersedes 96-253-2006 Rev.11•2PD8
<br /> PLEASE MAKE A COPY FOR YpUR RECORDS
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