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aa \6- <br /> soren--e_.- 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 /> I Applicant's Name Type of Ownership <br /> DESTINY CHURCH ASSEMBLY OF GOD r Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 644 S LOCUST ST HALL <br /> ❑Other(specify): <br /> City State Zip Cole State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Pallor Tm?,us+ L.0 I-0-4 S.WC/AS I- S>. Cortt.noISluxcl ,lt-k. Lo fiboi <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,It necessary. <br /> Registration Date or <br /> Motor Vehicle Make I ModelYear PodyType I Vehicle ID Number Date of Acquisition, <br /> C��11�(,,�� a Newly Purchased <br /> •.3 _10 2010 Tra.ilor ISgBF,lallAlenoccr3 <br /> Exempt Uses of Motor Vehide: r Are the motor vehicles used exclusively <br /> ❑AgricutturalMorticultural ❑Educational 5s1 Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: 'WS <br /> �/-�,pe.(�cx'ry" 17LYES ONO <br /> t,i . a k J (It./ t O;n/fttr..r' lu't di/0 ' '" f e � If NN4 give percentage of exempt use: <br />• <br /> �tA.rW � / aim. t•) % <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 /> signs 11 - 11—I4 <br /> here ,.Authorized Signature Tate Date <br /> ,,--,r-,,�� FOR COUNTY TREASURER RECOMMENDATION <br /> 9 PRJVAL RECEIVED CLivIMENTS• •S ' ,, pied A S' $ ....46" n-a-a <br /> ❑DISAF PROVAL <br /> NOV 2 i 2014 <br /> Signatu�Treasurer Date <br /> HALL COUNTY FOR BOUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> n-APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> _b.. i _s�� /-/3 7`5 <br /> on -.-ign. ' Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 1103.185,and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supemedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />• <br />