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R16 <br /> Ng,kaDo1 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 aide. <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 0 Other(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 aurip Iuerk 4n3n w Rnspdalp Rd poninhan NF 68842 <br /> Chair of Trirctpes t.yron Le:itenschlagpr 5767 W Binfield Rd Doniphan NE 68832 <br /> Church Treasurer park Haskins 240 W Binfield Rd Doniphan NE 68832 <br /> La Leader cott il. f.a. 1. • N f.. ' 11 . 11 t mil: <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> Chevy 2001 Express Van 1RAHr39R9112fl 7Rn <br /> MEAD'S) 1999 BUS 1r_BYP3287Y1304774 <br /> FILM BIRD 1999 BUS 1CB1xP37RXT33D6748 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 0 AgriaauralMorticultural 0 Educational ®Religious 0 Charitable ID Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: XI YES LINO <br /> To transport children to and from activities. If No,give percentage of exempt use: <br /> To transport youth group children to and from 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 1 am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or empl. nt based on race,color,or national origin. <br /> sign >/ Sul AI S-- &ivy //-//-/ Y <br /> here "th. ized Sign•u.. Title Date <br /> rut COUNTY TREASURER RECOMMENDATION <br /> RECEIVED 4 ,,t A, yam. *77— 47.0.2, <br /> 'E APPROVAL COMMENTS- <br /> E]DISAPPROVAL NOV 1 3 2014 <br /> af /-ei- /3- <br /> TRFHAGLLRCOCN1TYtCe i;Signaturent unty Treasurer Date <br /> GRAND ISLAND,NEBRASK$FOR COUNTY BOARD OF EQUALIZATION USE ONLY. <br /> APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL / / <br /> / s ,r.I, � /-13.73 <br /> Cr.rized Signature Dale <br /> Nebraska Department ci Revenue Authorized by Nett.Rev.Stat.gg 77-202(1)(x)and(d),and 60-3,185.and 60-3,1139 <br /> 96-253-2006 Rev.8-2011 Supersedes 9S-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />