Laserfiche WebLink
t <br /> r Mi�LZ Application for Exemption FORM <br /> r Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be tiled with your county treasurer. <br /> •Read Instructions on reverse side. <br /> 411 Applicant's Name Type of Ownership <br /> NEBRASKA DISTRICT COUNCIL OF THE ASSEMBLIES OF GOD ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1503 W 2ND ST. , PO BOX 1965 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802-1965 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> President/District Superintendent Dwight Sandoz,1891 Hardy Rd,St.Paul,NE 68873 <br /> Assistant District Superintendent Gary Hoyt,5109 Timberidge Dr.,Papillion,NE 68133 <br />• Secretary!Treasurer Terry Brown,6450 Foxglove Ln.,Lincoln,NE 68504 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> _ if Newly Purchased <br /> Buick 2006 4 Dr.Sedan 1G4HD57266U149280 1/21/12 <br /> Dodge 2006 Sport Van 2D4GP44L06R838228 1/21/12 <br /> GMC 2007 4 Dr Spt Utility 1GKFK16387J190781 8/15/12 <br /> GMC 2002 4 Dr Spt Utility 1GKFK66UO2J134011 1/21/12 <br /> HRH Trailer 2010 Cargo 4J6TC14215B065201 1/21112 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturalHorticultural ❑Educational N Religious ❑Charitable 111 Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: .3 YES ❑NO <br /> Vehicles and trailers are used to transport Nebraska District Assemblies of God employees, No,give percentage of exempt use: <br /> • <br /> If volunteer staff, and equipment to Assemblies of God churches and events in Nebraska and <br /> to National Assemblies of God functions in the U.S. for the establishment and promotion of <br /> the Christian faith. <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 o ,color,or national origin. <br /> sign I--- e-7t Director of Operations 1213/12 <br /> here I Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ► • i e A/SS 77- toy <br /> [V]APPR�rVAL Cr MMENTS: <br /> ❑DIS• •PROVAL DEC - 3 20;2 <br /> tk° -� � is- 3 ---,tad' <br /> HALL COUNTY c at unty <br /> Treasurer Date <br /> 1a 'MD -AND,NEBR- FO' COUNTY BOARD OF EQUALIZATION USE ONLY <br /> .V APPROVAL COMMENTS: <br /> ❑DISAPPROVAL / <br /> ,, <br /> /'�..- - e -S, /tI /f'AS-lelo/_4 <br /> u orize• ignature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§5 77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2311 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />