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� �� <br /> ���-� Application for Exemption FORM <br /> Nabraska Department of <br /> REVENUE from Motor VehicleTaxes by(lualifying Nanprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> ApplicanYs Name <br /> "�" Type of Ownership <br /> ABl.1NDANT LIFE CHRISTIAN CENTER �Nonprotit <br /> Street or Other Mailing Address Counry Corporation <br /> 3411 W FAIDLEY AVE HALL �Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> 7itle Name,Address,City,State,Zip Code <br /> EPr���l G, l.�A-QR�Ai�R 3DQ�.Y7�ANo A1/E G�PAA1� [ Al F <br /> �� /YI L 8 S. � A � / <br /> R�A.S u R�lZ �l! S !-l/y1� I! iE PA ' � fJ E �u So <br /> 17ESCRIPTION QFTHE MQTpR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> MotorVehicle Make �odelYBar BodyType Vehicle ID Numher Date of ACquisition, <br /> if Newly Purchased <br /> o F- 9-P F� RF F Er3 <br /> o I 9 � �f U� AG a �l3 0 <br /> ta i �r l EnC�./ose �f X ' <br /> Exempt Uses of Motar Vehicle: Are the mvtor vehicles used exclusively <br /> �Agricultural/Horticultural ❑Educational �Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed descriptlon ot use,including an explanativn if multiple use classifications exist: �YES �NO <br /> A�� (lQ��`(��$ (,�� (A$(1� �o �fYV7'15�Q,�rf Vario�ts C�UI'�11 �'/'�fJG[�S IfNo,givepercentageofexemptuse: <br /> ,,�� :��:, <br /> (1 _. <br /> C�i?G� ��iPir{�t�� �� Qft�G� -�ra�n U�ur�t /Yl���`n�s � CcCfi�i-�res. E .:��:��� �� <br /> f�- , . ; ��11 <br /> Under penalties of law,I declare that I ha examined this application and that it is,to the best of my knowledge and beli f,true,complete,and correct.I <br /> also declare that I am duly authorized to s n this exemption applicatinn,and that the organization owning lhe above-liste property does nvt discriminate <br /> in membership or employment based on ace,color,or national origin. - �r 1r•IrY <br /> � ` ?'-. . ...-. ..=n�FICE <br /> � C3F: ..�;!<A <br /> Slg �t_5���-'-��` ( /� <br /> here d ignature Title Dat �w� <br /> FOR COUN7Y7REASURER RECOMMENDATION <br /> [�APPROVAL COMMENTS� � <br /> �]pISAPPROVAL ----- <br /> "c3,�l �� _c�9^�� <br /> \ .. . �.11 J ._ <br /> �gnature of County Treasurer Qate <br /> FOR COUNTY BOARD OF E�UALIZATION USE ONLY <br /> �PPROVAL COMMENTS: ' <br /> ❑I]ISAPPROVAL <br /> /:� /�. <br /> Authorized Signatur 17ate <br /> Nebraska department of Revenue Aulnorized by Neb.Rav.Stat.§§77-202(1)(c)snd(d),and 60-3,185,and Fi0-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253•20a6 Rev.5-2009 <br /> PLEA5�RETAIN A CpPY FOR YOUR RECORDS. <br />