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2e it <br /> g rasksDa�pertmz-- Application for Exemption FORM 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 /> 0 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 />• <br /> Title Name,Address,City,State,Zip Code <br /> President/District Superintendent Robert Wine,207 E.54th Street PI ,Kearney,NE 68847-8531 <br /> Assistant District Superintendent Gary Hoyt,5109 Timbertdge Dr.,Papilion,NE 68133-2757 <br /> Secretary/Treasurer Terry Brown,6450 Foxglove Ln.,Lincoln,NE 68504-4634 <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 /> it Newly Purchased <br /> Dodge 2006 Sport Van 2D4GP44L06R838228 1/21/13 <br /> GMC 2007 4 Dr Spt Utility 1GKFK16387J190781 8/15/13 <br /> GMC 2002 4 Dr Spt Utility 1GKFK66UO2J134011 1/21/13 <br /> HRH Trailer 2010 Cargo 4J6TC14215B065201 1/21/13 <br /> Avenger 10 Enclosed 1996 Utility Trailer 4T6FB1014TM002744 11/6/13 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculfuralHorticullural ❑Educational ®Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: CI YES ❑NO <br /> Vehicles and trailers are used to transport Nebraska District Assemblies of God employees, <br /> volunteer staff, and equipment to Assemblies of God churches and events in Nebraska and <br /> 0o National Assemblies of God functions in the U.S.for the establishment and promotion of No,give percentage of exempt use: <br /> v <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 on race,color,or national origin. <br /> Sign C Ll� DIRECTOR OF OPERATIONS 11/26/13 <br /> here Auth6ilzod'Signature Title Date <br /> FnR r oUNTY TREASURER RECOMMENDATION <br /> �PPROVPL RECEIVED _y,2, ..4.. ? 5 '77 .j <br /> COMMENTS: <br /> ❑DISAPPROVAL DEC 2 c0 I3 <br /> HALL COUNTY 11 Signature of County Treasurer Date <br /> r rcEAis'ANRS-bPFlCl34e COJNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND(.Si ANII,_NEc-A <br /> 4 APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / At r J /-/'d?W144 <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 603.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />