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��--� Application for Exemption �=o�M <br /> Nebraska Department of <br /> RE'V'EN1 1E from Motar Vehicle Taxes by Qualifying Nonprofit Organizations 45,7, <br /> V •TO be filed with your county treasurer. <br /> •Read instructipns an reverse side. <br /> Applicantis Name � � 7ype of Qwnership <br /> Grand Island Evan elical Free Ghurch l._�,�� ���� • ���� <br /> g _.. _.. _ _.___...�. �Nariprofit <br /> Stt66t Of Othef Mailing AddrESS � County C01'pOlatlOn <br /> 2609 S Blaine St Hall <br /> _ _ � ❑Other(specify): <br /> �ity State Zip Code State Where Incorporatod <br /> Grand Island NE 68801 NE <br /> IDENTIFY OFFICERS,DIR�CTORS,OR PARTNERS OFTHE NONPFtOFIT ORGANIZATION <br /> Title Name,Address,City,5tate,Zip Code <br /> Eider Ghairman William Feely,2524 Stagecoach Rd,Grand Isiand,NE 68801 �� <br /> Gorp Treasurer Julie 5chuyler,24D5 N Guster Ave,Grand Island,NE 68803 <br /> DESCRIPTION OF THE MO70R VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> flegistration�ate ar <br /> MotorVehicle Make ModelVear BodyType Vehicle 10 Numher Data ot Acquisitian, <br /> if Newly Purchased <br /> Ford�350 XL7 5D EXT Wagon 2011 ~Van T� W 1 F8SS3BL5BD617181 ��� 5/10/2D12 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exGlusively <br /> �Agricultural/Horticultural �Educational 0 Fieligious ❑CharitaBle �Gemetery as indicated? <br /> Give detailed description bi use,including an explanation i(multiple use classific ions exist: R�r��w�,j�r D �YES �NO <br /> ��� � r L <br /> Transport people, supplies, and equipment to events. <br /> It No,give percentage of exempt use: <br /> �fi1 � � �L / <br /> HALL.COUNTY <br /> �T'REASUR�RS OF�'ICE <br /> GRA�IG ISLANt],NEBF2ASKA <br /> Under penalties of 12w,I declare that I have examined this application end th2t it is,to the best of my knowledge and 6elief,true,complete,and correct.I <br /> also declare that I am duly auihorized to sign this examption appli�ation,and that the organization owning the above-listed property does not discriminate <br /> In membership or employment based on race,color,or national origin. <br /> sign 9 �. � <br /> Financials 5/10/2012 <br /> here Signature Title Date � <br /> FpR COt1NTYTkEASURER R'cCOMMENbATIQN <br /> ❑APPRbVAL COMMEN7S: ��� �5„S 7�� `�G�' �., <br /> �p15APPROVAI. .._u__» __..._._._._ <br /> a��� .S��f/�� <br /> Signat e ot County Treasurer Date <br /> FOR COUNTY BDARD OF E�LIALIZATION USE ONLY <br /> �APPROVAL COMMENTS: <br /> �DISAPPROVAL <br /> a��a/�. <br /> Authorized Signature Dafe <br /> Nebraska�epartment of Pevenue Authoriied by Neb.Rev.Stat.§§77-202(1J(c)and(d),�nd 60-3,185,end 60-3,189 <br /> 96-253-2006 Rev,8•2071 Supersedes 96-253-20D6 Rev.5-2048 <br /> PLEASE RETAIN A COPY FOR VOl1R RECORDS. <br />