Laserfiche WebLink
�n ��- <br /> ���� Application for Exemption �o�M <br /> Nabraska Department of <br /> �`���E from Motor Vehicle Taxes by Glualifying Nonprofit Organizations A 57, <br /> �/G •To be filed with yaur county treasurer. �� <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> 5U17ANESE EVANGELICAL FREE CHURGH �rvonprotit <br /> 3treet or Other Mailing Address Counly Corporation <br /> 2609 S BLAINE ST HALL �Other(speciTy): <br /> Gity State Zip Code State Where Inwrporated <br /> GRAND 15LANb NE 68801 NE <br /> IDENTIFY O��ICERS,DIREC70RS,OR PARTNERS OFTHE NONPROFIT ORGANIZATIpN <br /> Title Name,Address,City,State,Zip Code <br /> � C, :r Ca c� �nc i.� � � . - c F',°• <br /> `z � �� L-�,..�.� �,.w.,w,.,-`� �� �.,� �. c ��S g�� <br /> � <br /> pESCRIPTION OFTHE MdTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> '° Registration Date or <br /> MotorVehicle Make ModelYear BodyType Vehicle ID Number �0te of Acquisition, <br /> If Newly Purchased <br /> G C� ��C�r� \ �'` �.j �V� =� ��S L`� 4�a <br /> q�C <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> �AgricuHuraVHorticultural � Educational [7�Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description vt use,including an explanation if multiple usa.•classifications exist: �YES �NO <br /> If No,give percentage of exempt use: <br /> �Sa�.�.5�c;��, p,r2A���Z �u �.�12--.."yCS <br /> \ <br /> ���EIVED <br /> ,,�., � , �oT� <br /> ,�.. � <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and beli f,true,complele,and wrrect.1 <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-liste property does not discriminate <br /> in membership or employment based on race,color,or national origin. HA!._l COUN"fY <br /> 7'F2EAv!JREF2S OFFICE <br /> GRAND IS;_ltiNf],NEBRASKA <br /> 5��� � �� ��n�t,.,����-a L�`"1`\ \\ <br /> �'7�f'Q� Auth rized Signature Title Date <br /> � FOR COUNTYTREASURER RECaMMENDATION <br /> �PPROVAL COMMENTS: �s �"l �'�-� <br /> ❑DISAPPRQVAL <br /> \ ��''LfdJ/� ..fr(d-n'� �a'3 `-'�`�J'°�/ <br /> Signature of County Treasurer Date <br /> FOR CDUNTY BOARD OF EQUAI.IZATIQN USE ONLY <br /> PPROVAL COMMENTS: <br /> ❑DISAPPROVAL � <br /> /�/� <br /> uthoriaed Signature Date <br /> Nebraska Department oF Revenue Authorized by Nab.Rev.Stat.§§77-2p2(1)(c)end(d),end 60.3,185,and 60-3,189 <br /> 96-253-2006 Rev.e•20��Supersedas 96•253-2006 Rev.5-2009 <br /> PLEASE R�TAIN A COPY FORYOUR RECORD5. <br />