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<br /> �� Appiication for Exemption �ORM
<br /> Nedraske�epartmant of
<br /> REVENUE from Mator Vehicle Taxes by Dualifying Nonprofit Organizations 457
<br /> •To be filed with your county treasurer.
<br /> •Read instructions on reverse side.
<br /> Applicant's Name 7ype of Ownership
<br /> NEBRASKA ANNUAL CONFERENCE OF UNITED METHODIST CHURCH �]Nonprotit
<br /> Street or Other Mailing Address County Corporation
<br /> 207 N PIN�S7 STE#102 ���� ❑other(specity�:
<br /> Gity State Zip Gode State Where Incorporated
<br /> GRAND ISLAND NE 68801 NE
<br /> IDENTIFY pFFICER5,DIRECTORS,AR PARTNERS OFTHE NONPROFIT pRGANIZATI�N
<br /> Title Name,Address,City,Stale,Zip Code
<br /> �� - �, �I � �1 F�3r��� ���� l�l� ��r�3/
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<br /> C.I4 �
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<br /> -1`r� ,. ,� �c b; >, }�. ,l�, ,f- 33 3 3 �—:z..J m��k C •�I � l�( � L-�5��
<br /> <3�, ,— 5 / k �-,6. C . �1 .r��.�, 1V l� G'��a
<br /> DESGRIPTION OF THE MOtOR VEHICLES
<br /> •Attach an additiona[sheet,if nec�ssary_
<br /> "` Registration Pate or
<br /> Motnr Vehlcle Make Model Year BodyType Vehicle ID Number �ate of Acquisitipn,
<br /> 1T Newly Purchased
<br /> C:�� � ✓ V' c c�R 4 �'�-ro ✓� T 1 G' N n� ��f�3 R (�� c�"7
<br /> �
<br /> � ,,,� .� 2c�in � �� ✓ 1.. S G�� r `IM37 r�tzu`i r� _ - .
<br /> Exempt Uses of Motor Vehicle: � rn Are the motor vehicles used exclusively
<br /> �AgriculturallHorlicultural ❑Educational [�'Heligious ❑Charitahle ❑Cemetery as indicated?
<br /> Give detailed de5cription of use,including an explanation if mulTipls use classiFications exist: �"ly�S �ND
<br /> �/`�� L b y �,.,��•-r i e '�" �i c. �.r�v��.^c�°','rt � --�ra r�� �c �G�s. S _...`_,.......�.._..
<br /> � � If Nv,qive � rTSpt'u$e i � �
<br /> 5 t�-�� S�..i�'�-Y l/\"�j��^�� ����..�-L u r s �.�/ C. h c�r r�Gv g — /G� �G �N� '"�aox�.:,
<br /> ��SGti� r��r-�a� f cr� � C���ri h�S ,
<br /> DEC 1 5 �t�'"1
<br /> Llnder penalties oi law,I declare that I have examined this application and that it is,to the best of my knowledge and be f,true,com 1 �.h�TY
<br /> also declare that I am duly authnrized to sign this exemption application,and that the organization owning the above-list propert�����S�i���FICE
<br /> in membership or employment based on race,cvlor,or nafional origln. ��`' ���A�F��
<br /> A/
<br /> i� / y,
<br /> s i g n L ✓"`.., .,/� r"���'-'�-- U��r;c� S�.,,e r,y, c�� ��°/{�-- / l
<br /> , 7� � Title Date
<br /> ��'+�"� �Authori 'd Sigr.ature
<br /> FQR COUN7YTREASURER RECOMMENDATION
<br /> �APPROVAL COMMENTS' � 7 �"' d�-'
<br /> ❑DISAPPROVAL
<br /> � �a-- 2���t i
<br /> �Signature of County 7reasurer Date
<br /> FOR COUNTY BQARD OF EQUALIZATION U5E ONLY
<br /> AI'PROVAL CbMMENTS:
<br /> ❑DISAPPROVAL
<br /> /�—/,�-
<br /> thorized Signatu Date
<br /> Nebreske Departmeni ol Revanue Authorizad by Neb.Rev.SIaL§§77-202(1)(c)and(d),and 60-3,185,and fi0-3,189
<br /> 96-253-2006 Fiev.B-2011 Supersedes 96-253-2006 Rev.5-2DO9
<br /> PL,EASE RE7AIN A COPY FORYOUR RECORDS.
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