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r <br /> 070/,3 <br /> Nebraska nyn Department of 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 /> • FIRST PRESBYTERIAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2103 W ANNA HALL <br /> ❑Other(specify): <br /> City Slate Zip 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,State,Zip Code <br /> S'., its— 45-4. 390 GJ _ / + i( ci &-, d, £ Gds13 <br /> f ', V9 `/15' / f►- /� i . 7./E e,es'03 <br />• <br /> 6W/1y_ ��� %_- �__:._ ._ 0 aL_ , - -, - ! - _J ' £ -8'• 63 <br /> / / <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 ED Number __Date of Acquisition, <br /> f',�1a.r) 94'/6"70gOO 07._... __-/qqg" �ja.o2t U� /...a. IG4Hrn37.3 <x 10 4SV0Ir Newly Purchased <br /> C.k� r,2 oo o //a'gnc-At-i<-c <i 47-SE ti 6 !NO.2/9.32 <br /> Gm�Cm.`r mod IGKp/V ,--t vi X05 5d1 47r <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ,Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: / /! jj YES LINO <br /> -� -{ e / � � `Yl'+-fir —/ie-�-- bra- aF-u,r- /-` ,7� <br /> ����� c- -q-a-� If No.give percentage of exempt use: <br /> .7�pie <br /> //�✓ a- emery.- i}�2--¢ j ZL--4 Lam✓/ <br /> i _ <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 membership or employment based on race,color,or national origin. <br /> sign <br /> here orized Signature Tie Date <br /> I E COUNTY TREE�AyS�URER RECOMMENDATION <br /> Qi APPRC✓AL RECEIVED C MENTS: Ao� ° j t Ala 77- a, <br /> ❑DISAPPROVAL NOV 2 9 2012 <br /> NALL COUNTY Signature of County Treasurer Date <br /> TRr-A3URCR3 OPCIOC <br /> GRAND ISLAND,NEBRASKAFOR OUNTY BOARD OF EQUALIZATION USE ONLY I <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> �•Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202111(c)and(d),and 60-3,185.and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-2532000 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />• <br />