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20/V <br /> ..„n....—,- , - 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 /> aziniii 'Read Instructions on reverse side. <br /> pplicant's Name Type of Ownership <br /> FIRST CHURCH OF THE NAZARENE ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1022 W 6TH ST HALL ❑Other(specify): <br /> City Stale Zip Code State 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 /> -5,Log blue CoJPmon 101) w Lo th (jrrontQ zslancl, KV (of38Ol <br /> prcl Yneml'jer r3on Twe-,3zer _14_50o ua•Cl•op■ en Pc) CP,■ro 1\)E U. .%< 4 <br /> Tc'eogur-c Y.a+h' Sets . e',ize c 19-100 %A) enapmon RA Ocurn sU E to&'W4 <br /> Q iraVimerrAa-a¢- to.TN LjhcA'eVl Boy. 132, ( alto OE to$ska4l <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> I _ Registration Date or <br /> MotorVehicle Make Model Year Body Type Vehicle ID Number -Dale of Acquisition, <br /> if Newly Purchased <br /> C /99 €550 5 t• 'i. e r :s :374;A,,1 <br /> n - •n <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ilg Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: YES ❑NO <br /> 4110/ireh A Yj \01,4 If No,give percentage of exempt use: <br /> v % <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 <br /> —./. i i.. .. . . 12-1°,g5urte_. //-/g <br /> i here Auth,ized Sig :tare r Title Date <br /> FOR COUNTY TREASURER�R�ECCCOOMM-MENDATION <br /> ErAPPROVAL RECEIVEQOMMENfS: j�e� " A' .�_7��°�/ <br /> ❑DISAPPROVAL NOV 1 9 2013 <br /> Met 1 CDUti'YY Signature of County Treasurer Date <br /> TREASURERS OFg1OUN1 V BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NES <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> h.• Authorized At , -� < I� <br /> thorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1)(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 />