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e ----z— 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 /> Applicants Name Type of Ownership <br /> NEBRASKA ANNUAL CONFERENCE OF UNITED METHODIST CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2418 N WEBB RD#1 PO BOX 5048 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ` ._ ■ .1T1Et1_��g rti S. Dot " 11 fro e M Be s 831 <br /> Ni . DI, „!�!! llllllllll'Letirnz • — i S `Z+I. "IllerlOrMit ` di <br /> WeO4 of arso - Van . Lot ._ • . _ ?5o <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> , , ._ _._... _ i_._._ -._ _. _ _. _ -AryiabaNvrv2eteor._ _ <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased _ <br /> ttonlnA Zoo? cR - v - EX J'HLRE 4l8n4cartO60 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural 111 Educational [A Religious 111 Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an(explanation if multiple use classifications exist y�.�� \��, ®YES ❑NO <br /> a i 1' ;.e.J, c r At k-On-. J )`ski-a- C\"" J s. r `."" ts If No,give percentage of exempt use: <br /> - osp\-txt\ E <br /> ltt v i tS • <br /> 'm ;c fi S .. 0SL r+ t\ om 4- t ±rccu2 is G c foss I � <br /> r-� t <br /> 5 (J se Jas- -o6 4 6eSO1.,Yci r3c1, CA-\c&cc.E.s_J <br /> Under penalties of law,I declare that I have examined this appliatidn 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 , / //�.ce P/% *flier- cSv eielr7QtSw- ti-//gor3 <br /> here Auto ig(i ttuure ° Tit Date <br /> F COUNTY TREASURER RECOMMENDATION <br /> RECEIVED k ,t - a <br /> L.',APPROVFt CMMENTS: <br /> ❑DISAPPROVAL NOV 1 COTS <br /> k- 91jX : .v64 -' A.3 --f ' <br /> HALL COUNTY ,Signature of County Treasurer Date <br /> TREASURERS OFFICEFOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> rsQA/Jn tSr naan <br />• <br /> g APPROVAL COMMENTS: it <br /> ❑DISAPPROVAL <br /> • ih Al C -- C 6 °/x' <br /> Authorized Signature ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)end(d),and 60-3.185,and 60-3,189 <br /> 96-263-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />