Laserfiche WebLink
Gail <br /> qaten ca-- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 457 <br /> •Read instructions on reverse side. <br /> •Applicant's Name Type of Ownership <br /> THIRD CITY CHRISTIAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 4100 W 13TH ST HALL <br /> El Other(specify): <br /> City State Zip Code State Where Incorporated <br />• <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,Stale,Zip Code <br />• E•A er5 cia tie n Lane c. cedes 2,5ro r kkiew Dr Gs tie &ago I <br /> rCQSLL re R, 'Sc eji tlt.cM'on , 32 fanag rose. Dr, e_r1, e 1,2e03 <br /> acre-{-cu 1 aei ry euf+-MeLi ( 2G4o N. NOPffi la.6." iMe (6803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> l —_—_. _...—. . _.Registration Date or i <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> FORT) /crib • its .515'43(-'{70°13 <br /> ropo-econo(2 ne Vcur . 00r3 n 3.EDnr(FS 1%LVAj.2-ogo <br /> "ria-etio ibvia.1 )9 gr7 {bug .4Ifv A13 V.V1a0IRoa8 <br /> ( te-bira IggiS pus 1.151W.2 e5 fta wrb777oa <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural 111 ,may Educational ' Religious ❑Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: (�� rrv��y,,, 17d YES ❑NO <br /> 1-h e 2' b“.5 -5�r� tA IV v`JPd `'' n r0� C2fl)WC�— u� crlf No,give percentage of exempt use: <br /> •l'hc 3 IBid` s and vein may be t 1 - I -Coi vnlc I fipk nurv;�1fi es <br /> 34- t4 Gh( Ci r?5rhain (Lcrc\ <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 mployment based on race,color,or national origin. <br /> sign [ q,20 /F/743 <br />• <br /> here /Autho ed Signfltu Title Date <br /> t.vury i ITREASURER RECOMMENDATION <br /> RECEIVED <br /> APPROVAL COMMENTS: A <br /> ❑DISAPPROVAL NOV 2 2 L u1 i3 <br /> HALL COUNTY r ,e _/ <br /> Signatureo Cou Treasurer Date <br /> TRFAS(MFRS OFFICE <br /> GRAND ISLAND,NurstSf#JTY€OARD OF EQUALIZATION USE ONLY <br /> 14APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Al /-14010/54 <br /> • /Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Nab.Rev.Stat.%77-20211)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev 8-2011 Supersedes 96-253-2006 Rev,5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />