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<br /> Application for Exemption �oRnn
<br /> T4 BE FILED WITH from MotorVehicleTaxes
<br /> YOUR cOUNTY qy Qualifying Nonprofit Organizations 457
<br /> TREASUR�R •Read instructions on reverse side T e of Owner
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<br /> 5T PAULS I.UTEIr.KL�,�T C}IURC�I HALL X�Nonprofit
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<br /> •—--��""' -' County Number Corporation
<br /> Street or Other Mailing Address
<br /> 1515 S HARRISOA7 _.,.40 . _.._..,. ❑other(s�ecify):
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<br /> --�- --�' State Zip Gode State Where Incorporate
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<br /> GRAND ISLAND Y3E 688Q3 NE _.
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<br /> Identify bfficers,�irectors,or ParinPrs ����` - ;- �1 • --
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<br /> 7itle � � Name.Address,Crty State Zip Code
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<br /> LIST SPEGIFIC DESCRIPTION OFTHE MOTOR VEHICLES
<br /> -Attach additional sheet if necessary
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<br /> � -• - " - Reyistration Date or�ate
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<br /> Model Year [3ody Type Vehicle Identification Number of Acquisition i1 fJewly
<br /> Vehicle Make °urcl:asad
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<br /> ._—�..— .- -- - - Are the motor vehicles used
<br /> Nature of Use�t Motor Vehicle: exclusively as indicated?
<br /> �Ayricultural/Honicultural �Educational `�Reliyious ;�Charitable �Cemetery
<br /> �YES �NO
<br /> Give detailed description of usE,including an ex�lanation if multiple classifications exisC
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<br /> Under penalties of Iaw,I declare that I have examined this application and,to the best nt my knowledge d belieT,it is correct and �
<br /> complete.I also declare that I am duly authorized to sign this exemption application,and ihat the organization ow ng said property does not
<br /> discriminate in membership or employment based on race,color,or nalional origin. Hqt 1 COUNTY
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<br /> — ,Aut�1µf d Si na FpR GOUNTY TR Title ' ;��
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<br /> el�e EASURER'S RECOMMENDATION _.,._ —.__..—
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<br /> [�PRbVAL C�MMENTS: ��n �Z}� "" -"
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<br /> g of County Treasurer Uate
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<br /> Y BOARD OF E�UALIZATION USE ONLY
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<br /> ❑APPROVAL GOMMENTS: __...�_ _ -l'
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<br /> Aut orized ignatur�
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<br /> ._-�.. ���� - - " ��� � Authorized by Ne6.Rev.Sfat.§7�-2P2(1)(C)(d),§60-3,1£35 y60-3,189
<br /> Nebraska Departmoni of Rovenue
<br /> 96-253•2006 Rev.5-2009 Supersedes 9f-253-20D6 Hev.11-2008 P�EASE MAKE A COPY FOR YOUR RECORDS
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