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• <br /> men— 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 /> "'Applicant's Name Type of Ownership <br /> DONIPHAN UNITED METHODIST CHURCH ®Nonprof it <br /> Street or Other Mailing Address County Corporation <br /> 303 N 6TH ST PO BOX 188 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> DONIPHAN NE 68832 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> lr°d`I6:nl`�*i A c` 'tx ut"r _.tc? yD C1 U.� 'DSL'c�- '- �►Oi7i , n-,.) - `b' Z <br /> .i o-{l- Y s f e t e S d . , _ u - A alt e. • r k w Il le, • , - gireLi.LL <br /> km-J1 iceaSU re r- , cx Pa-s- Jr1S :29Q !.J .jfh 4:70 ' 1f'R as ijolw , k bRR32 <br /> Lay Leait(` 52t el i r7�l�'ii nr� Se b E P%tom.-'S P won?Iu.r.. e 6 8ri'32- <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make I Model Year Body7ype Vehicle ID Number Dale of Acquisition, <br /> _._. If Newly Purchased <br /> CHEVY 2001 EXPRESS VAN 1GAHG39R911205750 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural El Educational xi Religious El Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: tail YES ENO <br /> all/ /11 ) a c+'f v itke-s: <br /> '7� ��5 f' ! r�✓i TO a„� �r�'�' If No,give percentage of exempt use: <br /> rfPj ,� <br /> r a�s��rf- /Dtc iar�4 +0 �,� <br /> "cccw\ a-Ch v, ie s <br /> Under penalties of law,I declare that 1 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 memb, ip or employ t based on race,color,or national origin. ,,Q� <br /> sign .'a• i SAS AD .ij Ug's 12 -17 3 <br /> here Authorized Sig -ure / Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> iin <br /> c -4'-77T c?c-tr—gg- <br /> QAPROVAL MMLN'5: <br /> ❑DISAPPROVAL 55,pp <br /> DEC 2 0 2313 Sign of Treasure � Date ..9 -/r <br /> FOR COUNT”'BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> Es4PPROVAL GRAND ISLAND.NEBRialknem-5: <br /> ❑DISAPPROVAL ``L <br /> i1 Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),arr 60-3,185,and 60-3,189 <br /> 96-253-2005 Rev.8-2011 Supersedes se-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />