Laserfiche WebLink
avid <br /> ,ten—�� Application for Exemption FORM <br /> Nebraska Deponent 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 /> iiir pplicant's Name Type of Ownership <br /> DESTINY CHURCH ASSEMBLY OF GOD ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 644 S LOCUST ST HALL ❑Other(specify): <br /> City Slate Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> POSt-Or Toy, �t.s-I- - LP Lig S. Lor'.,cL S. C r(;t,r,(J±S IC0-4 &)C C9O5Ol <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 /> if Newly Purchased <br /> -)ho r p Low Try,. tor. (546E ID.ii isivifii3 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> III Agricultural/Horticultural ❑Educational Z Religious (11 Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> U-Sed. to 1-tcs'J- FS arinmt-� bor VDtcibc+f L'i'1wt fiik' <br /> U If No,give percentage of exempt use: <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 /> rsign OSm -�O-S1vf-- t1 - IL-L3 <br /> here ,Authorized Signature Title Date <br /> FOR COUNTY TREEAASURER RECOMMENDATION <br /> •'APPROVAL OMMt T5: 4 /7c , - A-,r '#j/� C2 <br /> RECEIVE Y z <br /> ❑DISAPPROVAL <br /> NOV 1 8 2013 (It) ''d( ''`..t) /S--/ <br /> Signature of County Treasurer Date <br /> FOR COUN rY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> 1 <br /> 'TREASURERS OFFICE <br /> TFAPPROVAL GRAND ISLAND,NEBRASI 4 r-ryTS: <br /> 7770 DISAPPROVAL <br /> 4111 • 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 />