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sog• cc1-.Dr23y ,?a/3 <br /> t -- 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 /> GQ •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> ! HARVEST TIME BAPTIST CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br />• 1125 N BEAL ST HALL <br /> El Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> I GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> 8 o%ta °i etric.;c 3e 0. E. 7a- CrentAti is<4A-c) N 6Fge; <br /> 'MOO fr(JgycNm-a, /7/0 N•T9y Met CAL44)0 ZLcLm.ad NA Srra i <br /> ifc,,.,cf`/ (d6©dM9N %/1 in hie/R0;24 NI 6 ' ,y <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 Newly Purchased <br /> Or c- - Jr,I- if Pre$C. ck trofr 2-8w83s z Tin S 95',c 1 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ®Religious ❑Charitable El Cemetery as indicated? <br />• <br /> Give detailed description of use,,iinncluding an explanation it multiple use classssiffiiiccations exist: h Ea YES ❑NO <br /> "TO Pi SIG U! /""P/'t � /v ydx f'c/L' 4i al�d If No,give percentage of exempt use: <br /> 0Fent tic ;o,4.c rte-�-ns ,.p,,n-.j s fo ctonto <br /> I cAaie4 /tici;CI es. <br /> Under penalties of .re 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 t - am duly aut'•rized to sign this exemption application,and t at thq organization owning the above-listed property does not discriminate <br /> in p or employment•,sad on race,color,or national origin. <br /> {sueig ,i1* I,0 . i 2 <br /> Jere 7-•nzed Signal - Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION�/ <br /> [TAPPROVAL RECEIVED OMMENTS: Ate--) it/.SS 77-2°,2, <br /> ❑DISAPPROVAL <br /> r Signature of County Treasurer Date <br /> HID t COVNTv <br /> TIr ASumeeS OFFICE F COUNTY BOARD OF EQUALIZATION USE ONLY <br /> �' !"?.;;a.rvm[s<ASKq <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / / <br /> �sri 7/./i /Jr_— r Q /S <br /> t on ignature r Date <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 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> i <br />