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<br /> 7o�����EOW�TH Appiication for Exemption FORM
<br /> from MotorVehicleTaxes
<br /> YOUR COUNTY by Qualifying Nanprofit Organizations ,457
<br /> TR�ASURER •Read instructions on reverse side
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<br /> ApplicanYS Name County Type of Ownership
<br /> SUDANESE �.VANGELICAL FREE (:L�URCH _ __ _.. _.__ AALL �]tvanprofit
<br /> Street or Other Mailing Address County Numbar Corporation
<br /> 2�]Q9 S ]3L�i�I1�E ST .. ., ,...�...._ _ .... ❑pther(specify):
<br /> City State Zip Code State Where Incorpnrated
<br /> GRAND IST�A N� 68801 NE -
<br /> IdFnhfy OfFicers,Directors or P . __ �., .. --- -..- -,-.-.
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<br /> artner5
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<br /> Tdle Name Address,City,State,Zip Code
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<br /> �._C''l c�!. �tf��.J•v ct a ' ��`�� `�.i�S..`�r .\...:.�Z-�' `� `.✓�t4 G.�\ �^- � �..'�\c.�. � �'�ti- �?�C���
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<br /> LIST SPEGIFIC DESCRIPTION pFTHE MO70R VEHIGLES
<br /> •Attach additional sheet if necessary
<br /> _._ _... I -- -... ,......_ Pur�clpase -- ,..
<br /> Vehicle Make Model Year [3od T e Vehi�le Idenhtication Nurn6er of Ac uis�n Date or Date
<br /> Y Yp ition it Newly
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<br /> Nature of Use of Motnr Vehicle: Are the motor vehicles used
<br /> �Agriculturai/Horticuilural �Fducational �Religious �Charitable �Cemetery exclusively as indicated?
<br /> Give detailcd description ot use,including an explanation ii multiple classifications exist: ES �NO
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<br /> ��y CZV�..`��']G:.:S V ��-�C`ti.7.�J\'C. �`� �.�'C_���.� ' f���� ■ '_ —�
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<br /> Under penalties of law,1 declare that I have examined this application and,to the best of iny knpwledg and belieT,it ispgprr�c�tandJ'i"t'
<br /> complete,I also declare that I am duly authqrized tb sign this exemption application,and that the organization o ning said�qpert;5t}t�s�nt0!ril"�
<br /> discriininate in membership or employment based on race,color,or national origin. GRqNU I5�ANr-%.rd�;�F�.�t<SA
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<br /> here ,AufFior ed Signature c� Title Date
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<br /> i ' �OR COUNTYTREASUR�R'S RECOMMENDA710N
<br /> �.�NOVAL COMMENTS: �L.L��_���� __.._ _..._..._._.._... . .-.--- —
<br /> � DISAPPROVAL _. _.... ----- --...-....
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<br /> , Sig ure o County Treasurer Date
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<br /> FOR GOUNTY Bl]ARD pF E�UALI2ATION US�ONLY
<br /> ❑APPROVAL CQMMENTS: . -- ---
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<br /> C]D15APPROVAL —_... .... _. _... .. � _......_
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<br /> � Aut o zed Signatu Date
<br /> _.. .,. ... _.,... ._.-........_...._- ---°'_ ...-....-_ �:.�izeA by Nob.Rev.Sfat.§77-202(�)(�)(d),§G03,185§6p-�...,-
<br /> Nebraska Uepartmnnt of Revenue �!nutl 3,1II�3
<br /> 9G-253•2po6 Hev.5-2U09 Supersedas96-253-2008I�ev.11-2008
<br /> PLEAS�MAKE A GOPY FdR YOUR RECpRDS
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