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<br /> 70B�FILEDWITH Application �for Exemption F�RM
<br /> from MotarVehicleTaxes
<br /> YOUR cpUNTY by�ualifying Nonprvfit Organizations 4,57
<br /> TREASURER •Read instructions on reverse side _„_._
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<br /> Applicant's Name County �ype of Ownership
<br /> TRINI7'Y LTITHEIZAN CAURCH ��� �rvonprotit
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<br /> Street or Other Mailing Address � County Number Corporation
<br /> 2 a.2 � 12�H 5T . _ �i�_._.,.. ._ �Other(specify):
<br /> City Sfate Zip Code State Where Incorporated
<br /> GRAND 1SI.AND NE 6$$Ol _ N� __._..,_..-----.. .
<br /> _. . . _ -- ----- �
<br /> Identi(y C>fficers Directors,or Partners
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<br /> Title Name,Address City,State,Zip Gode _
<br /> --..,._
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<br /> Chairman Dan Haxries, 118 C�ntennial D.r, Gr:�nd Island NE_ b$$D.I_. _. _....
<br /> _.... _ ._, _..,
<br /> Vice Chairman Vacant
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<br /> Secretar L --
<br /> y �e Hazen,1�28 N Ruby, Grand Isla_nd NE 6$801 _..— ..__
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<br /> Treasurer Vacan�
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<br /> _ __,..
<br /> . _....
<br /> �oard of Truste�--Chair 1?arry Wilton,__235 �_ Airport .Road, Gra.nd Island.NE hRR(1'� __. ..._
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<br /> LI5T SPECIFIC DESCRIP710N OFTHE MOTOR VEHICLES
<br /> �Attach additional sheet if necessary
<br /> _� _.-
<br /> _.,,. __. _ _ —........ _ ..... _._......,..
<br /> �Registration Date or Qate
<br /> Vehicle Make Model Year Body 7ype Vehiclo Identification Nurnber of Acquisition i�Newly
<br /> Purchas�d
<br /> ..
<br /> � ...__. - ----
<br /> �---�-----..�
<br /> - ------- - .------------ .....---------- ----.... T---.._.... ._. ._
<br /> _.��Q��.. V2.T3 � W� � S�
<br /> �.. - �_- ,_____ _--
<br /> �StarTrans Ford 2002 Handica Van/bu • 1rDX�.45S22HA70066__
<br /> _._...,. . __.
<br /> .z-�-�e��U�iS_'��_ 1990 Homemade N/A
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<br /> _ _�_ _ ....._ --
<br /> �-�ieel i7ti1. Trlr 1970 Homemade N/A _,,
<br /> -- ------ - — _..._._
<br /> Nature of Use of Motor Vehicle: Are the motor vehicles u5ed
<br /> �Agricultural/Hor[icultural �Edur,ational �Reliyious �Charitable �Cemetery
<br /> exclusively as indicaied7
<br /> Give detailed dcscription of use,including an explanation it multiple classitications exist: �YES �ND
<br /> To brin� members to church and to take school chi.ldren to IfNo,gi ..��rc�'� g���.r`""� i
<br /> 5�noo� a�e�V�t��s
<br /> ��� ���� ���
<br /> , ��-� � �iit�,
<br /> Under penaltics of law,i declare that I have examined this application and,to the best oT my knowledg and belief,�s�.��� ��Fi�.�
<br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organization o nin saiQplY?RgJ�X;.y��C��oStf�,�RASKA
<br /> discriminate in membership or employment based on race,color,or national origin.
<br /> . J/ �� �
<br /> slgn .� �. ��� j_��u s�{��� � �/ 3Q/io
<br /> A�ed Si ature Title Dale f
<br /> here �
<br /> . . _._ . _ _ _._ _ _ .._ _ ..
<br /> FOR COUN7YTREASUR�R'S RECOMMENDATION
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<br /> �PPROVAL COMM�NTS: ._ . � / 1 ��.`c�G�Z� _..�... . -..,.
<br /> �]�15APPROVAL . � - - ._ -
<br /> U��J ._��_!-J .. !� G /�_
<br /> a �
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<br /> Signature ot County Treasurer� Date
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<br /> FOR COUNTY BOARD OF EOUALIZATION USE ONLY
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<br /> [�APPRQVAL COMMENTS� .�. ---..._.�......__
<br /> � ,
<br /> ( �_
<br /> ❑ DISAPPROVAL ---�.� .. , - , —.� _. .,. _._
<br /> � � �� ---�•,.
<br /> Aut ori�ed Si� � J~
<br /> / •- �._. _..�.,.,. __.._....
<br /> gnalure Date
<br /> l�/
<br /> . ....- --'-� ..._ ...................�--- ......... __..._._._..�.. ---....,_ .-_..-.—
<br /> Nebraska Popartment of Revenue Authorizad by Neb.Rev.StaL§77-202(1)(c)(d),§6U-3,185§GU-3.109
<br /> 9fi-253-2D06 F1ev.5-2009 SupB,ades 96-26�-200E Rev.11•2�08
<br /> PLEASE MAKE A COPY FOR YQUR RECORDS
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