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�v ��a�.. <br /> .�,•-L��- Application for Exemp�ion FORM <br /> Nebtaska Oupnrtmunt of <br /> REVENUE fram MotorVehide7axes by Dualifying Nonprofit Organizations 457 <br /> •To be flled with your county treasurer. <br /> •Read instructions pn reverse side. <br /> ApplicanCs Name Type of pwnership <br /> FIRST PRESBY�1°'ERIAN CHURCH �Nonprotii <br /> Street vr Other Mailing Address Counly Corporation <br /> 2103 W ANNA ST HAL.L �Olher(speciiy): <br /> City Stale Zip Code State Where Incorpora�ed <br /> GRAND 15LANb NE 68803 N� <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATIQN <br /> 7itle Name,Address,City,Sla1e,Zip Code <br /> res a �rp on ea i iver ran s an <br /> . res ent ro�rn ea ow ay ra� ran an <br /> egister� gen� Bruce Smxt 22 Arrowhea Rd Grand I� an NE <br /> C1erk of S.ession Mary lteitan Z203 �9k�.ahoma Ave Grand ISland NE 803 <br /> p�5CRIPTION OFTHE M070R VEHICLES <br /> •Attach en additional sheet,if necessary. <br /> Fleglstration Date or <br /> Motor Vehicle Make Model Year eodyType Vehicle I�Num4er Date ot Acquisition, <br /> if Newly Purchased <br /> Che� 991 8080 7 1 S o Van `��� 106S4Q4 <br /> Ca at ` 'x4TSE5?Y6YNp21934 <br /> Exempt Uses of Motor Vehicle: Are the mator vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational �eligious ❑Charitable ❑Cemetery <br /> as indicated? <br /> Giva dotailed descri�tion ot use,including an explanation If multipls use otassifications exist: �YES �Nb <br /> Transpo�'tation �f church members on Sunday; youth group to <br /> events; preschool field trips; mission trips; retreats; � ;��� <br /> meets--Events for church members and staff. <br /> �ov i 7 2a1� <br /> Under psnalties oi law,I decl�re that I have examined this application and that it is,to!he best of my knowledge and�eli ,true,complete,and.l�pr�GYl.1NTY <br /> slso daclare that I am duly authorized 1n sign this exemption application,and that the organizafion owning the above-listed property doe3F9�f,d����UFFIC� <br /> in membership vr employment based on race,colnr,or naiional origin. Gt�A��O ISV+NP,N�B�S� <br /> sign ��� �� �-�/ <br /> here orized Signature Title Date <br /> FpR COUNTYTR�ASl1RER R�GdMMENDATtON <br /> [J�PPRQVAL COMMENTS: � `"aVd�-� <br /> �DISAPPROVAL --- <br /> •J �� � <br /> Signature oF County Treasurer Date <br /> FdR CDUNTY BOARD OF EQUAIIZATION USE ONLY � <br /> �PPROVAL COMM�N75: <br /> []DISAPPROVAL <br /> - - �—`1= <br /> Aulhorized Signature Date <br /> Nebruska oeparlmeN or Revenue ��� m�� Aulhorizad by Ne�.Hev.Slat.§G��-202(1)(c)and(d),and so-3,185,and so-3,1 e9 <br /> 96•253-200Fi Flov.8-2011 Supersedes 9G253•2006 Rev.,5•2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORPS, <br />