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Nebraska Department of <br /> Application for Exemption FORM <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 /> ABUNDANT LIFE CHRISTIAN CENTER ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3411 W FAIDLEY AVE HALL <br /> ❑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 /> • <br /> Title Name,Address,City,Slate,Zip Code <br /> PREsISENr 315PNE-N G. LUAR21NER r30o8TLRIlo AVE GRRAMP SLAAO,, NE 4Z803 <br /> SECRETARY NANOY VANCE .305N WErZEL GRAAIVISLAAIvAIF68801 <br /> ?REASURek kEAI (DAP.REAI .34/6 111 ,STATE GRAA!➢SSLAU4IUE 68803 <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 Dale of Acquisition, <br /> if Newly Purchased <br /> FOEP F-56o T7/oonROA.23 01000 /(RVSTALeaceiIa4-Gas IFDRF56FgE8/5o55 <br /> OWEV 49o57oRno68 194.5" -Scar VAN IGAGG34KASF154630 <br /> TRAILER 14(00 02 101/EFL ENOIaSEP 4 )( to )( 7 <br /> CFIEVRoLET Ici90 /5o0 50610280.1 I6NEVIloktILF1/6410 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational Ill Religious ❑Charitable 111 Cemetery as indicated? <br /> r.� <br /> Give detailed description of use,including an explanation if multiple use classifications exist: <br /> / [ YES ❑NO <br /> i. 04/I !/elite es arc used 'fo I/ r1Sporf Val-is-us L'YIC(re/1 It If No,give percentage of exempt use: <br /> Grind eiaipinell fo rid 4onil Crl',ure` me¢/%np a4.4d cefhii -lies, <br /> eonlad : ,dorm i92eear/ti 2o/3-3802-V801 <br /> Under penalties of law,I declare Mat 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 si n this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or employment based on r ce,color,or national origin. <br /> 7 <br /> sig . -ok S; ki' 1 - /1-13 <br /> her 6-1-)zthorizt `.'nature o y <br /> Title Date <br /> R FOR COUNTY TREASURER <br /> _RECOMMENDATION AJ <br /> APPROVAL I R• CEIVEL�OMMENTS: "-IF-a v �/'�"j �" 'S°a5. "fl a_, <br /> ❑DISAPPROVAL NOV 1 8 2013 <br /> MN 1 Ca IIY}Y ,Signature of ounty Treasurer Date <br /> TREASURERS OFTPO COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ICLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> ,r-a fr C / -ili-aoiq <br /> P Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)Ic)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 />