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Appiication for Exemption FORM�01�
<br /> TO BE FILED WITH from Motor Vehicle Taxes
<br /> YoUR COUNTY by Qualifying Nonprofit Organizations 457
<br /> TFi�ASUR�R •Read instructions on reverse side _._..,,,_ __...., ___
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<br /> ApplicanYs Name County Type of Ownership
<br /> TRINITY U1�ITED METHODIST CHLIRCH . __ _ FIL�T�L __,. �Nonprotit
<br /> —..9. _....,- _ _ __.
<br /> Street or Other Mailin Address County Number Corporation
<br /> 511 N F,L3�1 ST _ ❑ot��er(specity):
<br /> —.__. ..—_ ._ _�.T�..__.� .. _ _._.,.
<br /> City State Zip Code State Where Incorporated
<br /> GRAND 'ISLAND NF. 6$$Q1 NE _ -- -
<br /> _. _.__ .
<br /> �d�ntify Officers,Duectors,or I'artnPrs
<br /> �_. __ _ � .. -_.... .._
<br /> Title Name,Address City,Stale Zip Code _ __
<br /> _ _ ___ �..... �
<br /> C,�4�cxti�'�t,a� Ma� n ��'�'.�s ��W l.ut�'�.s• �J6 6�8�� -7.25)
<br /> 1�2c TuM� . 3►�� ia,r� . ;.ivxFc� �i�d, �qtav�c. {�tu�c., _ _.._
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<br /> ., _ --- -- __...__� _._,. _..,
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<br /> LIST SPECIFIC DESCRIP710N OF THE MOTOR VEHICLES �
<br /> �� •Attach adddional sheet if necessary
<br /> � _ .._.�. -- , , _ -- Re istratiition if.,_
<br /> .,_ _ .
<br /> --- - on Date or Date
<br /> e Make �Model Year ^ Body Type VehiclP Identi6calion Number of Acquis'' Newly
<br /> e ic.._ _ —._ -
<br /> Pwchased
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<br /> Nature of Use of Motor Vehicle: Are the motor vehicles used
<br /> �Agricultural/Horticultural �Educational �Religious �Charitable �Cemetery �xclusively as indicated?
<br /> Give de�ailed description ot use,including an t:xplanation if rnultiple r,lassifications exisL' �Y@5 �Np
<br /> 1
<br /> �' � �� ���\� � i� ��\ �, �� �� � If No,give percentage:.--,......T %
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<br /> Under penalties of law,I deciare that I have examined this app� on and,to the best of my knowle�lge and beliei,it is correct and
<br /> complete.1 also deelare that I am duly authorized to sign ihis exemption application,and that the organizatio owning s2id�r t does nvt
<br /> qiscriminste in membership or employment 6ased on race,color,or national ori in. �&�Y CnJN7'Y
<br /> 9 TF'E!;<;UFt�RS UF`FlG�
<br /> C'�!"<A.�•Jf�1:.;'11;JD,NEE?RASKA
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<br /> � 11—(�I7" ((-'
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<br /> here �horiz�ign�e Title Date
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<br /> � FOR COUNTYTREASUFiER'S RECOMMENpA71pN
<br /> j�.14PPF'sOVAL COMMENTS: �-- /��_.S j'�'�-' � ��!_. .. .
<br /> ❑DISAPPROVAL ..__ . .-- __..._.....,.
<br /> 5i nature f���u�nt ��? J/ `�� �
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<br /> �--,..c..... ......., ..__.
<br /> y � y Treasurer Date
<br /> . _. _._ -- --.. — --_.. __. ----.. , . �
<br /> � FOR CQUNTY BOARD OF �U��ION USE ONLY
<br /> �APPRQVAL COMMENTS: ---
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<br /> � . � � 1
<br /> �DISAPPROVAL ---- ' -^� --- ,� --_..._....
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<br /> .-- — _._—..—._._.,� _�__....
<br /> Aulhorized Signature Date
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<br /> Nebraska�epertment vf Revnnue ^ Authorized by Neb.Rpv.SIaL§77-202(1)(c)(d),§60-3,185§GO-3,189
<br /> 96•P53-2006 Rev.5-2009 Supersedes 9F-253-2D06 Rev.11•2008
<br /> PLEAS�MAKE A CdPY�OR YOUR RECORDS
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