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• <br /> -385-0524 02:26:57 p.m. 11-06-2012 1 11 <br /> W/3 <br /> 1.19-1—e–_ 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 /> 411 Applicants Name Type of Ownership <br /> TRINITY UNITED METHODIST CHURCH <br /> ®Nonprofit <br /> Street or Other Meiling Address County Corporation <br /> 511 N ELM ST HALL ❑Otter(specify): <br /> City State Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> 1-4154-42P is IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title if Name,Address,City,State,Zip Code <br /> glen .frlaritul an o i Sir 6L, brandisland•NQ_ co g$,l� <br /> b Ens, berq 3ncl L4,kesid-e_ fa^. 6enndfsLafhL We.. (oSWl <br /> oxen ' 'tS$' aiab W. n ' t• i (nnf el-rclehIEf . Ills G, 'I <br /> e._. ,a. A,G :Lr, 0 / ),I i/ • i ti •,Y' -I <br /> DESCRIPTION OFTHE 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 Newly Purchased <br /> rhev5 I q-lci 13r d-,S cap(p 66.J Y l l to 20 .$)°gt- Otto(:tt <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgrtculturavHorticultural ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist kYES ❑NO <br /> • Cfuurch 0C r I()Ai& £ T If No,give percentage of exempt use: • <br /> • <br /> PreschS achouhe) ° <br /> twat. rda l-ed- a.017ot-hes <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 lam duly authorized to sign this exemption applicat ion,and thatthe organization owning the above-listed property does not discriminate <br /> in membership or employment based on race,coo,or national origin. <br /> Sign ifiAlgna____ i <br /> f-5=024x, <br /> here A er��t#- " ' Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> _ ` °` Aa. y.4"..51.-5- ?7--Pe ?AP OVAL ECEIV D MMENTS: <br /> El DIS PROVAL <br /> NO.,.. �, <br /> - 6 2ul2 - , 2, � //.a-�R_ <br /> l/Signature of County Treasurer Date <br /> I.E ;,, °n AUNTY FO COUNTY BOARD OF EQUALIZATION USE ONLY I <br /> Tr-it-J.cI c.-1cF <br /> &APPROVAL COMMENTS: <br /> ❑DISAPPROVAL / ' _'y//1 j) <br /> •N / _ • / .-sn/ �.v --_.L / V`•/V <br /> • -utho S. no Or Dale <br /> Nebraska Deparinen,of Revenue Auhtdsed by Neb Rev.Smt.§§77-202(1)(e)and(li),and 603,165,and 60-3,189 <br /> 96-2632006 Rev.8-2011 Supersedes 90-253-2006 Rao.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS, <br />