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� v� � <br /> ���� Appiication for Exemption �oRM <br /> Nebreska Departmeni oi <br /> REVENUE ��om Motor Vehicle Taxes by Clualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> �W__.__.u,..,.._. _..,__..----_ <br /> Applicant's Name 7ype of Ownership <br /> TRINIT�Y UNITED METHODIST CHURCH � mm �Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 511 N �LM 5T � HALL �ptner(specity): <br /> City Siate Zip Code State Where Inwrporated <br /> GRAND ISL.AND NE 68801 NE <br /> IDENTIFY pFFICERS,DIREC70RS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title �,C Name,Address,City,State,Zip Code <br /> ��O VL� �w t,a <br /> b 0 <br /> m �.�• <br /> �� pESCRIPTION OF THE MOTOR V�HICLES <br /> �Attach an additional sheet,if necessary. <br /> Registration�ate or <br /> Motar VehiGe Make Model Year � Body 7ype Vehicle ID Number Date vf Acquisition, <br /> If Newly Purchased <br /> _...___ _ r A 1 <br /> _. 7�.__ <br /> Exempt Uses of Motor Vehicle: ��� Are the motor vehicles used exclusively <br /> �AgricuHurai/Horticultural ❑�ducativnal �Neligious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed descri�tion of use,including an explanation if multiple use ctassifications exist: �YES �NO <br /> Church -+ Uresc.haol defiv�-hes and fri pS / fela-� ��iv+'heS <br /> NOU 2 9 2011 <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best oi my knowledge and beli ,true,complete, �r�N7y <br /> also declare that I am duly authorized to sign this exernpiion application,and that the organization owning the above-liste property doe��l��p���p����� <br /> in membership or employment 6ased on race,color,or national origin. G12.4NfJ IS!_AND,NEBRASKl1 <br /> . <br /> S 1 f�t'1 , (1 �_�s�C�GC�'rL. ____..._ �`l�\'CIeSS 1.1��.fY1��v �� <br /> . <br /> here ��ri�ed Signat re Title Date <br /> ��u FOR COUNTYTREASUIiER RECOMMENDATION <br /> �PPRPVAL CQMMCNTS: ���5 _�T.:r:..�°��°�—� <br /> ❑DISAPPROVAL <br /> ` ,����yI',.1-��-,... .---...�_----_. .. /a --a _ / / <br /> / Signature of County Treasurer Dafe <br /> w FOR CDUNTY BOARD OF E�UALIZATION USE ONLY <br /> �PPROVAL COMMENTS: ..._._ <br /> �p15APPRQVAL _..__. <br /> �-�J��--. ' <br /> uthorized Signature Pate <br /> Nebraska I]eparlmeN Of RovBnue Authonzed 6y Neb.Fev.Stat.§§77-202(1)(C)and(d�,and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.B-201 i Supersedes 96-253-2006 Rev.5•2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />