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070/3 <br /> sai^—L- 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 /> Applicant's Name Type of Ownership <br /> • NEBRASKA ANNUAL CONFERENCE OF UNITED METHODIST CHURCH gj Nonprofit <br /> Street or Other Mailing Address AL County Corporation <br /> -�B�N-taT-ST--1tQ2 <br /> O. 60-A 5 0ND 014(5 Ai W b Z <br /> HALL Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE -ease-t- g&O3- NE <br />• IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br />• <br /> Title Name,Address,City,State,Zip Code <br /> �(ryetiswr• 1Zn6;n K•t1gqofc 3333Lar,dmnrkBlvd• Llintof NE (-,,1509 <br /> Y1air 'Dr NIart a�ob 2ttt Rd M . Imo, tct' [- gg3 u. <br /> aa7 VA✓r C6-Ckr 511 W tf l iiin 5+. Gr,c,,t•.d i s la rA , f 68150/ <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 /> ooB9.•3 - 11111113:L`IL'iallaG.. ro 7a I U1i L,t WMW11- <br /> . . di • cog a 4. I. a t-t8589Cco- ..,. 5_._ zot2. <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 0 Agricultural/Horticultural ❑Educational 0.,14us ❑Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ES LINO <br /> • V X • " • x t, If No.give percentage of exempt use: <br /> 0 . too., <br /> ° <br /> Ro ; - st.o, , C YUAKCI — <br /> Under penalties of law, 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 that I am It authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership ore loyment based on race,color,or national origin. <br /> sign ■ , ,�� `Asre..c - ert u ll- ' '-13— <br /> here Signature Title Date' <br /> 1 FOR COUNTY TREASURER RECOMMENDATION I <br /> :I <br /> y 'PROVAL � C°°MMENTS:"���"7� ,'', ors`S .7� .rd'Z-. <br /> ❑DISAPPROVAL .iG'. — ') '?'":7 <br /> e /1-9_/2 <br /> HALL CUUKfy Signal eof ounty Treasurer Date <br /> Tmrr'C,X7.28 OrrICE <br /> GR1:. <i ISLAND,NEaRASKA FO' COUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL ,/� Art4 0A.4 <br /> • uthorize Signature Date <br />• Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185.and 60-3,189 <br /> i 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br /> 1 <br />