Laserfiche WebLink
��— 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 /> Applicants Name Type of Ownership <br /> • ST. STEPHEN'S EPISCOPAL CHURCH <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 410 W. 2ND STREET STE.#10 HALL <br /> 111 Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND, NE 68803 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Priest-In-Charge Rev.Timothy D. Raasch:410 W.2nd Street Ste.#10 Grand Island,NE 68801 <br /> Senior Warden Dave Jepson:#50 Sonja Drive Doniphan,NE 68832 <br />• Junior Warden Mike Timmerman: 110 Comet Ct. Alda,NE 68810 <br /> Financial Secretary/Treasurer Leslie Lewis:4239 New York Ave. Grand Island,NE 68803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> • Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> • _ if New Purchased <br /> Ford-Taurus 2007 4-door sedan 1 FAFP53UX7A148569 08/15/2008 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑ <br /> Agricultural/Horticultural Educational M Religious I:Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: el YES ❑NO <br /> Transportation for the Rector, Deacon, Parish Nurse, Parish Staff and or its members in <br /> If <br /> order to share the gospel, provide outreach and ministry to all persons, including shut-ins, No,give percentage of exempt use: <br /> •and the needy of Grand Island and beyond. Also used for travel to and from services, <br /> residences, and church meetings, conferences and youth events such as summer camp. <br /> Under penalties of law,I declare that I 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 I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in memberstt, or employment based on race,color or national origin. <br /> sign , ?ti! �- Financial Secretary/Treasurer <br /> 11/14/2012 <br /> here Adihort ignati re f Title Date <br /> COUNTY TREAASURREER,RECOMMENDATION <br /> [9APPR AL RECEIVED CC,MMENTS: 5 "J�• �!�%•� <br /> ❑DISAP OVAL `,u`,," ', F 251 ' 1 <br /> MAUL flT to Nitfi>` Signature fC0 ty Treasurer Date <br /> Tt. P <br /> rFrdye:un.i� ww =cNl` '•` UNTY BOARD OF EQUALIZATION USE ONLY <br /> VA-APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> • Authorized ignature r Date <br /> Nebraska Department of Revenue Authorized by Neb.Rea Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60.3,189 <br /> 96-2532006 Rev.6-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> 1 61/47. . 41 — Les /,'c Le ;is 4-36-1_3802 _ tnic <br />