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Application for Exemption Nebraska Department of <br /> FORM <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 /> ST. STEPHEN'S EPISCOPAL CHURCH <br /> ® Nonprofit <br /> �reet or Other Mailing Address County Corporation <br /> 422 W. 2ND STREET HALL El Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> RECTOR REV.ROBERT LEWIS; 1725 S.CURTIS AVE.GRAND ISLAND,NE 68803 <br /> SENIOR WARDEN DAVE JEPSON: #50 SONJA DRIVE DONIPHAN, NE 68832 <br /> JUNIOR WARDEN MIKE TIMMERMAN; 110 COMET CT.ALDA,NE 68810 <br /> FINANCIAL ADMINISTRATOR LESLIE LEWIS: 4239 NEW YORK AVE.GRAND ISLAND,NE 68803 <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 /> FORD-TAURUS 2007 4-DOOR SEDAN 1FAFP53UX7A148569 08/15/2008 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural 111 Educational © Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: .1 YES ❑NO <br /> TRANSPORTATION FOR THE RECTOR, PARISH NURSE, PARISH STAFF AND OR ITS <br /> If <br /> SEMBERS IN ORDER TO SHARE THE GOSPEL, PROVIDE OUTREACH AND MINISTRY No,give percentage of exempt use: <br /> Wo ALL PERSONS, INCLUDING SHUT-INS, AND THE NEEDY OF GRAND ISLAND AND <br /> BEYOND. ALSO USED FOR TRAVEL TO AND FROM SERVICES, RESIDENCES AND <br /> CHURCH MEETINGS, CONFERENCES AND YOUTH EVENTS SUCH AS SUMMER <br /> CAMP. <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 l 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 />• <br /> sig " _ FINANCIAL ADMINISTRATOR 11/1412013 <br /> her Au 'orized L ignature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> PPROVAL RECEIVE�OMME TS: S <br /> ❑ DISAPPROVA K-1 -(243.1z- <br /> Signature <br /> NOV 1 8 2W3 � ° <br /> of County Treasurer Date <br /> HALL COUNTY FOR COU TY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND NEBRASKA <br /> 'APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL '/ <br /> • /30-e u ` ��_ /—/5t 07oi'/ <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§T7-202(t)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />