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a,� ��- �� Appfication for Exemption FORM Nebraska Department of ��NVE from Motor Vehicle Taxes by Gtualifying Nonprofit Organizations 457 •To be filed with your county treasurer. •Read instructfons on reverse side. Applicant's Name Type of Ownership NEBRASKA C715TRICT COUNCIL OF THE ASSEMBLIES OF GOD �Nonprofit Street or Other Mailing Address County Corporation 1503 W 2ND ST PO BOX 1965 HALL ❑Other(specify): Cj�y � State Zip Code 5tate Where Incorporated GRAND ISLAND NE 68802-1965 NE IDENTIFY OFFICERS,QIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATIpN Title Name,Address,City,State,Zip Code Pres/District 5uperintendent Uwight A Sandoz 1891 Hardy Rd 5t.Paul NE 68873 W Asst District 5uperintendent Gary Hoyt 5109 Timberridge Dr Papillion NE fi$133 Secretary/Treasurer 7erry Brown 6450 Foxgbve Ln Lincoln NE 68504 u DESCRIPTION OF THE MOTOR VEHICLES •Attach an additional sheet,if necessary. '� �� Registretion Date or MotorVehicle Make ModelYear BodyType Vehicle Ip Number Date of Acquisition, if Newly Purchased Buick � 2006 4�r Sedan � 1 G4HD57266U149280 / -.�7�-i/ p�g� 2006 SportVan 2D4GP44L06°838228 ;-��-I/ �M� � 2002 4Dr 5pt Utility 1 GKFK66UO2J134D11 -�J-/ H&H Trailer 2�05 Utility Trailer �m 4J67C142158065201 � =�j-j/ .� _. �.�._,.....- -- -- Sharp 201D Cargo 159BE1217A1870613 /-�J-� Exempt llses ot Motor Vehicle: Are the motar vehicles used exclusively ❑Agricultural/Horticultural ❑�ducationat �Religious ❑Charitabie ❑Cemetery as indicated? Give detailed description of use,including an explanation it muttiple use classiFications exist: �YES �NO Vehicles and trailers are used to transpart Nebraska District Assemblies of God employees, volunteer staff,and equipment to Assemblies of God churches and events in Nebraska and �f No,g��e�� to National Assemhlies of God functions in the U.S.for the establishment and promotion of � the Christian faith. Local Contact: Mike Schaaf, Business Administrator Phone: 384-1234 NpV l 8 2011 Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and be ef,true,com f��iGtI1JTy also declare that I am duly authorized to sign this exemption application,and that the organization owning the abo�e-list proper ��83FFICE in membership or employment based on race,color,or national origin. � � ��-�V��'`°E^'RASKA sign Business Administrator 11/17/2011 here Aut rized'"�ignat 7itle Date � FQR COUNTYTREASURER RECOMMENDATION �PPROVAL COMMEN75: ��..�_.. h�� 'd � _ _.._.__..__ �DISAPPROVAL —,.__ _......�. .,� __W_�_...._.__.� ��5� c l Signature ot CounryTreasurer Pate FOR COUNTY B�ARD pF E�UALIZATION USE ONLY T� �PPRpVAL COMMENTS: �pISAPPROVAL ! �� uthorized Signature Date Nehraska Oepartment of Awenue T fwthonzed by Neb.Rev.StaL§§77-202(1)(c)anrl(d),and 60-3,185,and 643,189 9f.253-2D�6 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 PLEASE RETAIN AGDPY FORYOUR RECpRDS.