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inen_.--z____ Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> •Applicant's Name Type of Ownership <br /> ABUNDANT LIFE CHRISTAN CENTER ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3411 W FAIDLEY AVE HALL ❑Other(specify): <br /> City Slate Tip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,Stale,Zip Code <br /> Paso EAi7 .9TEP!/EA1 G. 8,19RR/NER 03008 Z PNo AVE GRAND 1S1AAJD,AlE 68/403 <br /> SteeeETARy A/12410Y VAAi0E 3(35 AL tUETXEA GRANVSSLAAP A/E 6880! <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> _. Motor Vehicle Make ModetYear Body Tye-- -. - Vehicle ID Number _ Date of Acquisition, <br /> if Newly Purchased <br /> Ford F-6 or-7i000ROor&3 ,-R000 K s-141 a940W-las /F7JArc&F9R31505.5 <br /> is : So .. to 0A, r 'IQ ' o.. F! ;:• <br /> Trailer I46o (Uhl Enelosod 1/ y' '1 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 1:1 Agricultural/Horticultural ❑Educational IZ Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist 4 YES 0 N <br /> If No,give percentage of exempt use; <br /> i <br /> ii 4/1 Ve e/es are used -/o Irans1oorf l�rrieus el°roll groups and <br /> ecari/JtNer1t -7o GiiPd from cAar&l 4101111S a al de-trr/lIieS, <br /> el- <br /> „Under penalties of law,I declare that have examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that 1 am duly authorize to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> i• ... •-rship or employment base on race.color,or national origin. <br /> here Authoriz'•Signature 308.353,_4361 Title C4 he41 6, Warr;ner Date <br /> C �� m !LR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL +yJ] C DMMENTS: 1444"ne / a"sS 7 2- -74'a, <br /> ❑DISAPPROVAL :,;(..).,1 1 1.c;2 <br /> 1,C? --- — it <br /> HALT.COUNTY r Signature of County Treasurer Date <br /> T^FPSURFftS OFFir F <br /> °HA..d is LAND NE 3RASl<A 4 p COUNTY BOARD OF EQUALIZATION USE ONLY <br /> IXAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL ' <br /> 0 -tiler' i_ -..."7i✓i _ - Ai% mac.. i ) G <br /> uthorize• ignatur� c4i <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(e)and(d),and 60-3.185,and 60-3,189 <br /> 96-253-2006 Rev,8-2011 Supersedes 98253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />