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�� �� <br /> ���-� Application for Exemption FORM <br /> Nedfaska�epartmant of <br /> �VENUE from Motor Vehicle Taxes by�ualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> - •Read instructions on reverse side. <br /> ApplicanYs Name Type of Ownership <br /> �ONIPHAN UNITED METHODIST CHURCH DBA LITTL.E MIRACLES CHILD CARE GENTER 2012 �Nonprofit <br /> Street or pther Mailing Address County Corporation <br /> 303 N 6TH ST PO BOX 188 HALL �pther(speciiy): <br /> CiYy State Zip Code State Where Incorporated <br /> DONIPHAN NE 68$32 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTH�NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> �l��-�45 -Z� <br /> Max En land 123 Meadowlark Cir poni han NE 68832 <br /> DESCRIPTION OFTHE MpTpR VEHICLES <br /> �AttaCh an additional sheet,ii neCessary. <br /> Registration Date or <br /> MoicrVehicl�Mak� MaualYasr BodyType Vehicle IP f�umber Date of Acquisitian, <br /> if Newty Purchased <br /> 2001 CHEVY SPORT VAN 20D1 EXPRESS VAN 1 GAHG39R911205760 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> []AgriculturaVHorticultural ❑Educational [�Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanatiqn lf multiple use classifications exist: �YES �NO <br /> To transpnrt children to and from activities. ir o,giveper������D <br /> To transport youth group children to and from ectivites. <br /> DEC 1 3 2D11 <br /> Under penalties of law,I declsre that I have examined this application and that it is,to 1he best vf my knowledge and belief, ue,complet S aFFIC� <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed p perty do�t�ifotldpq�iqAj�,NEBRASKA <br /> in membership or employment based on race,color,or national origin. <br /> SIgCt ��(.,f ` -rR��+Su�� 12 /3 2n/� <br /> here Authonzed Signature 7itle Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> � , — ---- <br /> [�APPROVAL COMMENTS: ����� -- ����a-�'� -- ----- <br /> ❑DISAPPROVAL <br /> , � . �� ��r-�'..�/ <br /> Signature of County 7reasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION U5E ONLY <br /> �PPROVAL COMM�NTS� <br /> ❑b15APPROVAL <br /> /�—J� <br /> Authorized Signature Date <br /> Nebraska Department of Revenua Authorized 6y Neb.Rav.5fat.§§77-202(1)(c)and(d),and 60-3,185,and 603,789 <br /> 96-253-2006 Rev.B-2o11 Supersedes 96-253-2006 Rev.5-2�09 <br /> PLEASE RETAIN A CQPY FOR YOUR RECORPS. <br />