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irk/1.---r--- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be flied with your county treasurer. <br /> ezcznimins •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> THIRD CITY CHRISTIAN CHURCH <br /> ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 4100 W 13TH ST 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 /> Tike Name,Address,City,State,Zip Code <br /> • `fits .;gym_r b L Ci 'des A _ VI - ' .- . ►. •;a <br /> tasu-dam r- Mush'ont 33" • .. • • „ i -f. . st9- s- Cg".b <br /> ceriYt (t.t1�rr a n %40 b1, nbctG. loom sslain-►l �i; (o 'Z0 ', <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 /> &P t- aJana 6 oo • 0co (ttta uey Se y%Mez j.tiociv-i 11-14-I'- <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgricultralMorhaltural [11 Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use.including an explanation if multiple use classifficc(aationnss exist: fj� " I'ES ❑NO <br /> Tit bus Will wia Vv a-i n"y tV r nOm 4- nr\ No,give percentage of exempt use: <br /> 1 awe , 1d- may (C)C. irk -Rvtr Mk{ m ust`e- <br /> bf-chivy City C.kers an Chug & r <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 emplaymenl based on race,color,or national origin. <br /> sign ( E J-'- ' Ghai(pia 0 /7-/7-,9 <br /> here O.Authorized Signature p �� Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION c <br /> APPROVAL RECEIVED COMMENTS: ell/flirt �'f'2 4I5°1 #77 <br /> ❑DISAPf ROYAL <br /> NOV 2 0 2014 StC ' °M //- 7/-/t <br /> i1 Signature of County Treasurer Date <br /> HALLCOUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> 1:l APPROVAL COMMENTS• . <br /> ❑,DISAPPROVAL <br /> '—e _ <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60.3,105,and 605,189 <br /> 9e-2532006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />