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40/9
<br /> pa+et- _— 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 /> GRAND ISLAND EVANGELICAL FREE CHURCH ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 2609 S BLAINE ST HALL ❑Other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68803 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,State,Zip Code
<br /> L–,vAlt--,'ci C✓V�c.\c....,.,. A ' c)w'\ 1v'-)--� �z„3a�c5 r CCC,a..(k -Sect-.rkvle LS C)\
<br /> C..--�Si.1c<>as.. c.. S.-.tiC1<\.. ..,�v. lL-",.O5 :m. cu,k,_,\t.i C•:rn.�aS-Z<-k.<_-,ck ;\E 1..C%.
<br /> <: K c,3 I
<br /> , \
<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 /> Fn k E• 3O st v∎ Core.. ., _ ".1.wr Vim, IC-1: 5,3Cr.5 c,,1zv-v vs\
<br /> 1 V Q;SS'}1.u.i:k\at\-Wl3>
<br /> G-tu-� -,.�,t,,,,_ .I,co VCASi; c,-o S ,h,,-ct ,-.., -\ C--S C'',96a_'n L'AO 'to,ac
<br /> $-o- St v2.,QJ 03 l-‘-:C\:e..."i6.,A<r ,),y,L! L-S.s.�153-„„.%cv`vS 3tk
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑AgriculturaUHorticultural El Educational El.Religious ❑Charitable El Cemetery as indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: [ YES ❑NO
<br /> —\.>f«s oc'o .ac Az A:mss 5� e�y Q k., eve is _
<br /> 3 \,Q , r,*'. No,give percentage of exempt use:
<br /> III \,•C)
<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 /> �c� . X8As�k Lo, \j,_ \,_,
<br /> sign �: a.�.��s �,\ ,?s\- 0,3
<br /> here ,Au;ht d Signature Title Date
<br /> u FOR COUNTY TREASURER RECOMMENDATION
<br /> r/ APPROVAL RECEIVEDOMMEf TS /C2-0--n--' /v-SA -`77-„.9c-.7
<br /> ❑DISAPPROVAL
<br /> NOV 2 7 2013 i3-/v
<br /> It Signature of County Treasurer Date
<br /> HALL COUNT/FOB COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> TRCACURERC 01l-IOE
<br /> GRAND ISLAND,NEBRASKA
<br /> AAPPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<br /> / At ,e / —1174019t/4
<br /> • 11 Authorized 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 /> •
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