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aka' epa en Application for Exemption FORM <br /> REVENUE 1G e from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> IPA pplicant's Name Type of Ownership <br /> HARVEST TIME BAPTIST CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1125 N BEAL ST HALL ❑Other(specify): <br /> City State 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,Stale,Zip Code <br /> PnrerrL. Q t/V-I prgls lCK 31a- 7'9i (r-', A G 6g'ef01 <br /> lPe1 c(t {- f Jn ( 5e/AiA^o5 17/0 N h '/iy/ofL 6-Z. NE 41S-4_3 <br /> 13G/7foN/ Haut/ Jotnirvi 1 Ella LSD A tie NIA Ft' 6s81S <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> -- - - - - - -- Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> D 1250. 199i Rain Lain")) Q3 SO 245WQ3f'Z7MKg5/o&i SRiJ 20/1/ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> III Agricultural/Horticultural El Educational Religious ❑Charitable 111 Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: III YES El NO <br /> -Th PICK up p¢aio/C FO &v V9 q' -7 + 4c AD/Ot'T-s t7cytp4s If No,give percentage of exempt use: <br /> To C0i3OPd 160 i <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 em toyment S. ed on race,color,or national origin. <br /> sign 1��� ���s�n.ert_ ///av/3 <br /> here Authorized Signature • Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ❑APPROVAL RECEIVED COM RENTS: /—n'er .,A4214-. , S .---:7 ' act <br /> ❑DISAPPF OVAL NOV 2 5 2013 <br /> HAP t en MTV Signature of County Treasurer Date <br /> TREASURERS OFR t CC UNTY BOARD OF EQUALIZATION USE ONLY <br /> BRMi61SMltl8,IrEIb <br /> /APPROVAL COMMENTS: <br /> ❑DISAPPROVAL :fi^// y 90 L/ <br /> /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 r <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />