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aaiti <br /> e -, Application for Exemption FORM <br /> Nebraska Dope nment 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 /> ppticant's Name Type of Ownership <br /> FIRST PRESBYTERIAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2103 W ANNA HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code / <br /> ll'll'. aeai ,to/ <br /> A 4 I : :..�_ / i, / Ms <br /> / / <br />• <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> ! I --.Registration Date or- _ <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> P,heivv gel /c'0 ii0007 /999 ,'gra gad I64Hag9SfAC/o 6s Sc' <br /> . r.v',dat • .., "DO r S <br /> V /�� <br /> • • J /1 . s/ • f /Iis71 • 7 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> . as indicated? <br /> ❑AgriculturaUHOnicultural El Educational gRekgious ❑Charitable ❑Cemetery <br /> Give detailed description of use,including an explanation if multiple use classifications exist Q /„ %YES ❑NO <br /> "Atirci.t..<1....0 .4 .14-1-e---n-Z j•/ 42 "�(//% <br /> It 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 me m-rship or employment based on race,color,or national origin. <br /> here l da to % . ' .t- ia.-.4 jdL c -w //-/9—/3 <br /> Jere ' thorized Signature Title Date <br /> �// FOR COUNTY TREASURER-' }RECOMMENDATION <br /> ]APPROVAL RECEIVEaMM79: "" , A2415. .#77---g C-2-' <br /> ❑DISAPPROVAL NOV 2 1 2413 <br /> 'a/�®n,aiSS )ac Las-k- 7 ._9-75- <br /> Signature ooff''Clo�ounty Treasurer Date <br /> �p�SA Rpwg pe�arCOUNTV BOARD OF EQUALIZATION USE ONLY <br /> GRANQ ISLAND NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> / /�_atLr ` /-71-47 te <br /> Authoraetl Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§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 />