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020/3 <br /> Nebraska vn^-Zto, Application for Exemption FORM <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 /> • THIRD CITY CHRISTIAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 4100 W 13TH ST HALL ❑Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ,Elders afilrMan IA rni C, GerAos„vsro4rkJIPIJDr) GL, NE f�RRnl <br /> -r Pra rer B r i uc nn 372; Pnrvierncr Dr it t NET (p 88x3 <br /> 11 t.1 C ' <br /> - I_ - Y s kit • )in i).f\tYkh ? 1 ,I, NF (p%9t>3 <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 -f r n Vehicle ID Number <br /> f Date of Acquisition, <br /> YQYd }QQD 13AS .-r 85531 y3KR47Q 3 if Newly Purchased — <br /> e,,e - Ecnhnitne. Van „700 vas. l :, Lyt'i �a <br /> tier 1,3 II q� sus is 1 Ail g-G 4i 12IJ 1110 <br /> Exempt Uses of Motor Vehicle: .�L Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational 1 Religious ❑Charitable ❑Cemetery as indicated? <br /> �7" <br /> Give detailed description of use,including an explanation if multiple use classifications exist: T IV I YES ONO <br /> 3.�wda,e-j ditil m n14194 1-( et P , �o <br /> ✓'lX- 3 NitA0 W' V a b �u, li No,give percentage of exempt use: <br /> lY�.c rL�`usa <br /> at c9Pruhd CvL -an Cm <br /> Under penalties of law,I declare that I have examined this application and that it is,lo 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 membership orAnployment based on race,color,or national origin. <br />• sign �z - C %/- r,° - ,Z� - _ <br />• here I A thorifed Signaturg/ Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION _ <br /> APPROVAL COMMENTS: / 4 X35 77_ gaz <br />• <br /> ❑DISAPPROVAL ? <br />• <br />• <br /> Signature o County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> i11 APPROVAL COMMENTS: <br />• <br /> ❑� <br /> `t D-ISAPPROVAL RECEIVED , /, <br /> DEC• 7 .uthorized ignature / Date <br /> Nebraska Department of Revenue DEC 7 2012 Authorized by Neb.Rev.Slat.§§99402(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Sugrsedes 96-2532006 Rev.52009 <br /> PLEASE R e AIN A COPY FOR YOUR RECORDS. <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NESR4KSA <br />