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<br /> TO BE FILED WITH Application for Exemption FORM
<br /> from MotorVehicleTaxes
<br /> YOUR COUN7Y py Qualifying Nonprofit Organizations 457
<br /> TR�ASURER •Read instructions an reverse side
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<br /> Applican1's Name County Type o wners ip
<br /> TEI�RD CITY CHRI51"TAN CHTJRCH __I3ALL _.._. X�]Nonproiii
<br /> _.................., _... __
<br /> Street or Other Mailing Address County Number Corporation
<br /> �F1Qa W 13T� ST �Qther(speci(y):
<br /> City
<br /> � � � State Zip Code State Where Inc�rporated
<br /> GRAND IST,AND NE 68803 NE._. —
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<br /> Identtfy CJfficers Dtrect�>rs or Parincrs __
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<br /> Tille Name,Address,Gity State,Zip Code , _
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<br /> _�'�ci.SU_Y e'� ._,_._ __la r��Y1_ � t L_ ,�.�� _Q ev'' cL D� - .�- Yl� .�.�.
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<br /> LIST SPECIFIC DESCRIPTION OF THE MOTOR VEHICL�S
<br /> •Attach additional sheet if necessary
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<br /> . -• --- • - - Reyistration Date or Date
<br /> Vehir,le Make Model Year T 8ody Type vehiclP Identitication Nurnber of Acyuisition if Newly
<br /> � Purchased
<br /> � (�%d �_ ��n �:� ...
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<br /> Nature of Use of Motor Vehicle: Are the mntor vehicles used
<br /> �AgriculturaUHorticultural �Educational Religious �Charita6le �Cemetery
<br /> exclusively as indicated?
<br /> Give detailed descri��tion oi use,including an explanation if multiple classifications exist: I Y I Y�5 �Np
<br /> ��at
<br /> (J i� lM!�'-�.^�`^""_"Q a'k"�. L'WQ� 1. �+�'��l_�.�`l�-��Q�l.�.'�3�.=�'� n,grve�ercen�"�""�
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<br /> �� Under penalties nf law,I declare that I have examined this application and,to the best of my knowled e and belief,it i�d�o�rgct��r�`y
<br /> cnmplete.I also declare that I am duly authorized to sign this exemption application,and that the organization wning said�SfZlpo.My;ct�e�" tr�
<br /> disariminate in membership or employment based on race,color,or nationel origin, ��,,,,_,,n;'.'�:�A
<br /> sign r�,, �f � > ��� ,����� /�_�y-��
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<br /> here Aut onzed Signature 7itle Pate
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<br /> � � FOR COUNTYTREASURER'S RECOMMENnATION
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<br /> [�APPROVAL COMMENTS T�!3. .`U-S�S �I�''ri� �-
<br /> [��ISAPPROVAL ��_� / �, ! '''� _. ..._.._� :._f(, �-� f.
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<br /> Signaiure of County Treasurer Date
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<br /> FOR CPUNTY BQARD OF EDUALIZA710N USF ONL _
<br /> ❑APPROVAL COMMCNTS: __. __..,._ . _...._ m.—
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<br /> [�DISAPPROVAL —., - J� . • .,.� (` ����:. r� �.---._.,..... ..,......._.
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<br /> , Authonzed Signature�� � � Date
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<br /> Ne6raska Papartment of Revenue Au�horized by Neb.Rev.Slal.§77-2D2(1)(c)(d),§60-3,1Fs5§60-3,189
<br /> �Jfi•253-2006 Rpv.5-2009 9upersedes 96-253-2006 I�ev.11-200b
<br /> pLEASE MAKE A GPPY F�OR YQUR RECORDS
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