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�-�l.�, <br /> •��� Application for Exemption �o�nn <br /> Ne6�aska Department of <br /> REVENUE rtrnm MotarVehicleTaxes by Dualifying Nonprofit Organizations 45�, <br /> •To he filed with your caunty treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> IGLESIA DE DIOS EB�NEZER �Nonprorit <br /> Street or Other Mailing Address County Corporation <br /> 222$ N BROADWELL AVE PO BOX 486 HA�-�- ❑other(speciry): <br /> Gity State Zip Code State Where Incorporated <br /> GRAND ISLAND N� 688�2 NE <br /> IpENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NQNPROFIT ORGANIZATION <br /> Title Name,Addres5,City,5tate,Zip Gode <br /> �.�---. , <br /> rG .G�P �/G�"7 —i r��. Z (� �6ili 4 � �'. Z <br /> i.Y r.� O � V�� � ( <br /> , o� �.,,,.� L� . � Z� <br /> DESCRIPTION OFTHE MOTORV�HICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration pate or <br /> Motor Vehicle Make Mudel Year 6odyType Vehicle ID Num6er Date of Acquisition, <br /> if Newly Purchased <br /> � �.- z A � � a8 r . <br /> t7 � /.��/� <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> �Agricultural/Horticultural �Educational �Religious �Charitable ❑Cemetery as indicated7 <br /> Give detailed description of use,including an explanation if multiple use classifications exist: / (�e_„�� ��Y �YES �NQ <br /> � �_.z, � J G y�� ��-�1 <br /> / � �J�f (., � o�9� <br /> �GK�rr 5 '�'-'!� �.c�� ��'`-� e'ef� O <br /> �� � CGr <br /> 5�.�-•--�-- ��'..:-� D EC 1 5 2011 <br /> � u���� ��. ��� � <br /> Gy � �'�, / " <br /> Under penalties of(aw,I declare that I have examined this application and that it is,to the best of my knowledge and b ef,true,complete�_c�T.�. -�-�, <br /> also declare that I_am dui� 'zed to sign th' exemption application,and that ihe organization owning the above-list property dd����(�s�a��FIC� <br /> in members,h�p or empioym ased on rac ,�olor,or national origin. GRAMD I�LANp,NE6FtASIt{1 <br /> IV <br /> _.._ _ �. ,r— <br /> sign �z_ f /,� <br /> �vaY� Authorized Signature � 7itle Date <br /> FOR COUNTY TREASURER RECOMMENDA710N <br /> 0 APPROVAL CQMMENTS: �"� �� ��� <br /> �pISAPPROVAI. -•-- <br /> ` ) /�����// <br /> /Signature of County Treasurer �ate <br /> FOR COUNTY BOARD QF EdUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> _ ����_ <br /> Authorized Signatu Date <br /> Nebreska Aepartmenf of Revenue Authonzed by Neb.Rev.Stat.§§77-2tl2(1)(c)and(d),antl 60-3,185,and 603,189 <br /> 98-253-2DO6 iiev.8-20��Supersedes 96-253-2006 Rev.5•2009 <br /> PLEASE RETAIN A COPY FQR YOUR RECORDS. <br />