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Nebraska Department ni& 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 /> DONIPHAN UNITED METHODIST CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 303 N 6TH ST PO BOX 188 HALL Other <br /> ❑ (specify): <br /> City State Zip Code State Where Incorporated <br /> DONIPHAN NE 68832 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Lp Code <br /> Chair of Admin Team Laurie Lueck 4030 W Rosedale Rd Doniohan NE 68832 <br /> Chair of Trustees ron Lautenschlaser 767 1 :in ' - . -:. i.. ' ... . <br />• Church Treasurer lGEa7:m.'intai :n•Siftirs:G :trey .1.. . tnmu: : <br /> La e..er f... W7rittg ... utna fnagnia.. <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 /> It Newly Purchased <br /> • <br /> Blue Bird 1999 Brit 1GBKP32RXX3304774 10-1-14 <br /> Blue Bird 1989 B„S 1GBKP32R9X3304748 10-1-14 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational 5 Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications twist: RIVES ❑NO <br /> To transport children to and from activities. If No,give percentage olexempt use: <br /> To transport youth group children to and from activities. <br />• <br /> For transportation to church activities. <br /> Contact name: Rev. Kelly Karges 402-845-2761 <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 /> sig <br /> All <br /> her: % . ature tie D 4 <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> �PROVAL RECEIVED COMMENTS: ,4 /� ��� 7 ^w , <br /> ❑ <br /> oisAppRovAL.NOV 2 1 2014 <br /> ././-a/-AV <br /> IPSignature of unty Treasurer Date <br /> NALL COUNTY <br /> TREASURERS OFFICE FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> x,-�1,, ORANU ISLAND,NEIRHWKA <br /> IyJAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> f�r8�i 0/4/02ZeLIZ <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Aulroreed by Net Rev.Stat.§§77-2020 He)and(d).and 60-3,195,end 903,1 <br /> 93-253-2005 Rev.a-2011 Supersedes 9a-253-200a Re.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />