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<br /> TO E3E FILED WITH Application for Exemption �o�M
<br /> from MotorVehicleTaxes
<br /> YOUR CpUNTY by c�ualifying Nonprofit Qrganizations 457
<br /> TREASURER •Read instructions vn reverse side _._,_,.�
<br /> �.,. _ . . —_ _.._
<br /> Applicant s Name County Type oi Ownership
<br /> S� STEPHEI�T�S �PZSCOPAL CHUKCH -.--_ HALL. __..,._..�_ �Nnnprofit
<br /> . ..- -..-- — ....
<br /> Street or Other Mailing Address County Number Corporation
<br /> �+10 W 2ND ST STE 10 _._. Q ❑Other(specify)
<br /> City State Z�p Code State Where Incorporated
<br /> GRAND ISLAND NE 6$801 NE ---- . .
<br /> .. _---. __ _—... ..�
<br /> Identify Officer�,Qirectors,or Partners
<br /> � - ... -
<br /> Title Name Address,City,State,Zip Code
<br /> _..
<br /> _. . _.—_.
<br /> �'�...`�C..., _... —_.,. �l�r l�c �, n�a.�__.�.�--�.,?il ��)����:�,"����--.,{�3-��$�f}�--._.,._
<br /> �.e na._n_�...�I a.r_de-r�_...—.. R�r lr��Y o�.�a O�e�e�R�n�a�F E-C 8 8 3� _ __._
<br /> ,Ti�n.i�]-��.inTa rr1P.Y�.... 8o����k�o•��� T^�v�3r3.._�..� --���. *T�v�--._ ..
<br /> �C�r �.#-�d....�G�c i�r-�-�--Y o...� ._,T c�circr�r�i a �� `Y�e��7�P����� V 1 1Vi E_ V V V V J.._......�...._,
<br /> _ , .. ... -._ ....,... .-. .......,. �
<br /> LIST SPECI�IC�ESCRIP710N pF THE MO70R VEHICLES
<br /> � _ •Attach additional sheet if necessary
<br /> � . -_..._ _. _._ _.__ __ _._
<br /> __�... _
<br /> Registraiion Date or Date
<br /> Vehicle Mako Mvdel Year [3ody Type Vehicle Identilication Number of Acquisiiion if N'cwly
<br /> Purchased
<br /> � _,.., - ---__- -. _.
<br /> R
<br /> �,._ _._ ,--
<br /> __�r-c,�i- _ , .•;z��s_ ����-..... -daor sedan P53UX7A].4856_9 ..... . 8 1512Q.p_$
<br /> _.,.. __ ..._ _......._ _ _.._ _ _
<br /> Nature of Use of Motor Vehicle: Are the motor vehicies used
<br /> �Agricultural/Horticulturai �Educational �Religious �Charitable �Cemetery
<br /> exclusively as indicated?
<br /> Give dUtailed description of use,including an explanation if multiple classilication5 exist: �YE5 �NO
<br /> I'ransporta�ion for Rector , Deacon , Parish Nurse , Pari.s �fNv grveper'centage r � /
<br /> ta�f and or a.ts members in order to share �he ,. < �� � i ��o
<br /> ospel , provide out-reach and minister to
<br /> 11 persons , including shut-ins and th� n��dy of GI , �6� �,� �.��
<br /> all County , ' and beyand . Also , travel to & from
<br /> ervices , residences , & conferanc�s .
<br /> � Under penalties oT law,I�declare that I have examined this application and,to the best of my knowledge and belief,i�js.correct_and _a�� T
<br /> complete.I also deelare that I am duly authorized to sign this exemption application,and that the organization o ning sai�prope,rty does ppt �`��1f.-;�
<br /> ,.
<br /> discrim ate in membership or et�ployment ba d on race,color,or national origin. - - °-----^"- " '""""'-"'"�""
<br /> � ,
<br /> h� �h Financial Secretary 11/15/2010
<br /> g, _. __ _ __.._..— -----....--
<br /> � e uth d Signaturo 7itle �ate
<br /> --- -- —.... _ �.,...._.._ _..,_�
<br /> .. ... ,_ _.,. _...
<br /> l F�R COUNTYTR�ASURER'S RECOMMENDATION
<br /> _,. _ . __..
<br /> �APPR�VAL COMMENTS: �_L�L__ �f ����
<br /> n DISAPPROVAL —,__ _...._ ...
<br /> �-�'��-�,� �`�-� -,�
<br /> -- - -- .
<br /> Signature of County Treasurer patP
<br /> _
<br /> .._,. . __ _..... _ __..,_. �
<br /> � � FQR COUNTY BOARD OF�RUALIZATI
<br /> []APPROVAL COMMEN75: --- –. , .-- ---
<br /> �
<br /> �DISAPPROVAL r
<br /> � �� , �
<br /> _.,_ _.�.. ,. .,_. __. . __.,,.... _,,_._
<br /> � / •I r
<br /> v \ x='-...-- _._ ..
<br /> Authorized Signature Date
<br /> _., _... ..._ ..,- - -- ..,—
<br /> 96-?.53-2o06 Rev,5 T��Yiorized by Neb.Rov.StaL§!7'-202(1)(c)(d),§6U-3,185§60-3,169
<br /> Nebra5ka De arlment of Revenuo
<br /> •2009 5upersedes�JF�253-2006 Rev.11-2008
<br /> PLEASE MAKE A COPY FOR YOUR R�CORDS
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