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�ar_�._. <br /> ���- Application for Exemption FORM <br /> Ne6raska�epartment of <br /> R���c from Motor VehicleTaxes by�ualifying Nonprofit Organizations 4c� <br /> G •To be filed with your county treasurer. �� <br /> •Read instructions vn reverse side. <br /> ApplicanYs Name Type of pwnership <br /> ST. STEPHEN'S EPISGOI�AL CHURCH � Nanprotit <br /> Street or Other Mailing Address County Gorporation <br /> �410 W. 2NQ STREET STE. #10 HALL �Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND, NE 68801 NEBRASKA <br /> IDENTIFY�FFICERS,DIR�GTQRS,OR PARTNERS OFTHE NONPROFIT OFiGANIZA7IQN <br /> Title Name,Address,City,StaYe,Zip Code <br /> Rector Fr.Charles A Peek: 152�4 Coventry Lane#56 Grand Island,N� 688D3 <br /> Senior Warden Dave Jepson: #50 5onja Drive Dpniphan,NE 68832 <br /> Junior Warden Bob Allispn: 2520 W.John Street Grand Island,NE 68803 <br /> Parish Treasurer Leslie Lewis: 4239 New York Avenue Grand Island,NE fi8803 <br /> DESCRIPTION OFTHE MOTOR VEMICLES <br /> �Attach an additional sheet,if necessary. <br /> Registration aate or <br /> Motor Vehicle Make Mpdel Year eodyType Vehicle ID Number Qate pf Acqulsltion, <br /> if Newly Purchased <br /> Fprd-Taurus 20D7 4-door sedan 1 FAFP53UX7A148569 08/15/2008 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusiv�ly <br /> ❑Agricultural/Horticultural ❑Educational Q Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description ot use,including an explanation if multiple use classifications exist: �YES �NO <br /> Transportation for Rector, Deacon, Parish Nurse, Parish Staff and or its members in order to <br /> share the gospel, provide outreach and ministry to all persons, including shut-ins, and the oC <br /> needy of Grand Island, Hall County, and beyond. Als� used for travel to and from services, G <br /> residenc�s, and church meetings, conferences and youth events such as summer camp. <br /> ��� � � ��� <br /> Under penalties of law,I declare that f have examined this applicatipn and that it is,to the best of my knowledge and belie true,complete,}1Y�L��qtlN7Y <br /> also declare at I am duly authorized to sign this exemption applicatipn,and that the organization owning the above-listed roperty doe3'IAH�I��O���C� <br /> in memb h or empinyment based on race,color,or n onal origin. C3RF,rvf7 ISl.AiJD.NE.BRASKA <br /> � � <br /> S�g Financial Secretary/Treasurer 12/14/2011 <br /> he thorize nature Title Date <br /> Ft"iFi COUNTt TR�ASUR�R RcCOMMENDATIOiJ <br /> [�APPROVAL COMMENTS: �� N-S5 ��"� °�"v� .. <br /> ❑DISAPPROVAL. <br /> � W /oi �a�� {1 <br /> �Signature of County7reasurer Date <br /> FOR COUNTY BOARD pF EQUALIZATION U5E ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> ����� <br /> uthorized Signature Date <br /> Nebraska Departmont tlf Revenue Authorized by Neb.Rev.Stat.§§77•202(1)(C)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.B-2011 SuperSedes 96-253-2006 Rev.S-2009 <br /> PL�ASE RETAIN A COPY FOR YOUR R�C�RDS. <br />