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��:��� <br /> ���--z� Application for Exemption �o�nn <br /> Nadraske Department of <br /> REVENUE from Motor VehicleTaxes by Dualifying Nonprafit Organizations 45,7 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> ApplicanYs Name Type of Ownership <br /> FIRST CHLIRCH OF Tf-IE NAZARENE �Nonprvtit <br /> Straet or Other Mailing Address County Corporation <br /> 1022 W 6TH ST HALL <br /> �pther(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND N� 68801 N� <br /> �pENTIFY OFFICERS,DIR�CTORS,OR PARTNERS OFTHE NONPROFI7 ORGANIZATION <br /> Title Name,Address,Ciry,State,Zip Code <br /> "� �'C� � O � LC� r��sT` 8O� <br /> T"j� � /�7 AJ � �L✓ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> —�- -�--- --�'- -" -°"'� Registration Date or <br /> MotorVehicle Meke ModelYear BodyType Vehicle ID Number Date of Acquisition, <br /> tT Newly Purehased <br /> 16�.�.R�3Si ~-/� <br /> Exempt Uses of Mntor Vehicle: Are the motor vehicles used exclusively <br /> �Agricullural/Horticultural ❑Educational eligious �Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classificativns exist: ES �NO <br /> [JS�1� onJ�.. � �'o,� C�jca� rn����-y <br /> ��� <br /> C��..�i/tC� ���i.=> <br /> �.��5'��,�. 6��,� �X�� ��� ���, D E C - 7 2011 <br /> Under penalties oi law,I declare that I have examinsd this application and that it is,to ihe best of my knowledge and beli f,true,complete,�;qo�eal..�kyT'Y <br /> also declare that 1 am duly authorized to sign this exemption application,and that the organization owning the above-liste property doesp�ai�scr�maFe nf-��CE <br /> in membership or employment based on race,color,or national origin. GRP.rJI]��:LAf:'.-%,-"_�"°°-�K"q <br /> si9n � ��-��2, _ 1 <br /> here Authonzed Signature Title Date <br /> FOR COUNTYTREASURER RECOMMENDATIpN <br /> �PROVAL COMMENTS: ��� �°v <br /> ❑DISAPPROVAL <br /> . � �ca�'1� _ _/..v3 ;�7--�/ <br /> Sig�County Treasurer Date <br /> FOR COUNTY BOARD QF EC�UALIZATION U5E ONLY <br /> �PPROVAL COMMENTS: <br /> []DISAPPROVAL <br /> /�..3 �/�-- <br /> uthorized Signature Date <br /> Nebraske Departmant vf Revenue Autnor¢ed by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60•3,185,end 60-3,189 <br /> 96-253-2006 Rev.B-2011 Suparsetles 96-253-2006 Rev.5-2009 <br /> PLEASE RE7AIN A CPPY FORYDUR RECORDS. <br />