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<br /> � Applic�tion for Exempti�n ,�,,s i � Fo�,�
<br /> TC1 B��ILED WITH ' from Motor VehiCleTaxes > ��
<br /> Ypu�couNrY qy qualifying Nonprofit Organizations 4,�"7'
<br /> 7R�ASl1RER � •Read instructians nn reverse sidc
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<br /> Applicant'5 Name Caunty "lype ot Ownership
<br /> Grand Island Evangelical Free Church Hall "�j{ NoriProfit
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<br /> 5lreet or pther Mailing AGdress County Numl�er Cnrporation
<br /> 2609 S Blaine Street 40 .. ............ ❑ome�{5pe��ry�:
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<br /> City Sta1a Zip Code State Where Incorporatec
<br /> Grand Island NE 68801 NE -------
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<br /> Ident�fy Otticers Dlre.,tors,or Pa�tncrs
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<br /> Titte Name,Address,Cdy,5t�le Zip Code
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<br /> �Ider Chairman Greg Epp,804 W 8 Road,Giltner,NE 68841
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<br /> Corp Treasurer 5andy Lawrey,2519 Commerce Ave,Grand Island,NE 68801
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<br /> OR VEHICL�S
<br /> sary
<br /> LI57 SPECIFIC p�SCRIPTIO
<br /> _�,.........._ _..... ......._...— •Attach additiunat st�eet it n�ces.............._...._... �.�..,...r....__._.. . ........._._ _
<br /> Registration Uata or Date
<br /> Vehicle Make Model Year Eody Type VF;Y�ir,Ifl Identification Number of Acyuisition ii f�lewly
<br /> Purchased
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<br /> GMC Savana G3500 1998 Ext Sport Van 1GJHG39R3W104�1300 ; 2/23/2011
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<br /> Nature of Use at Mptpr Vehicli: Are the matqr ve ic es use
<br /> �AgriculturallFiorticultural ��tiucational �X Religious �Charitahle �Cemetery ��Clusively as indicated?
<br /> Give d�tailetl description of use,including�n exnlanatibn if multiple classifications exisY. �YES �NO
<br /> Transport peaple, supplies, and equipment to events. .
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<br /> -- cnm lete.I so declare thet I am duty authonzed to sign this exempt on application,and that th. F^ —_._................__._ _................,....
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<br /> lJnder en�lties ot law,I deciare thai I have examined this a licaiion and,to the best of mq knowledge and beliaf,it is correct and
<br /> p ' e organizatipn o ning said p� e fy''ilo�eS�ioF��'�T�`
<br /> discriminate in mea�bership or employmenY based on race,cvEar,vr trational origin. ��F•�'1��'����-��'FICF
<br /> GR; 't7 i:; - ` PJI_E itA',KA
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<br /> ���\ � «�� Financials 2/28I2D11
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<br /> Authori ed Signature Title �[i1e
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<br /> � FOR COUNTYTREASUFiER'S RECOMMENDATIQN
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<br /> (�J APPROVAL COMM�N`�S: „"`'� lL�.SS ���" `� L!`'U
<br /> �]QISAPPRbVAL /
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<br /> //� � r � /y
<br /> `l'r � � , '�i�7� Aly
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<br /> Signature of County Treasurer � ' Date
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<br /> FOR COUNTY BQARD OF EQLIALIZATION USE ONLY
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<br /> �PPROVAI. COMMEN7S: — ------........................................�--
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<br /> ❑C11SAi'PROVAL —..........,. ��f _.......�.--- ' --...__._............................._ __.......................�_�
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<br /> Aut -��.(.,. _'�'y " ��._.._...........................!iZ •� �L_U!.�.w;�°%
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<br /> Nei�ra5ka Dcpartment of Wpvenue Au:hnriz�d b Neb,Fev�Sl2C 67+-202(1)(c)(d),yGL'-3,785§f+0-3,i 8d
<br /> 96-?i3-2006 Rev.5-2Q0�Supersedes 96-253-200G Ficv.11-2U08
<br /> PL.EASE MAKE A COPY FQR YOUR RECORDS
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