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<br /> Ne�--� Application for Exemption FORM
<br /> braska 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 /> Applicant's Name Type of Ownership
<br /> FIRST CHURCH OF THE NAZARENE ® Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 1022 W 6TH ST HALL 1 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,State,Lp Code
<br /> P11r■ Dq,.t Z:94M.E_ /it/ Li, 6 o t- /n6'. (..,,,',Ft/
<br /> .mow- ! Ea r/ f4 u s.f r "WO [Lr � 1. ., n Ate. ��b `1/7 c
<br /> 'ry.d fee/eic,,'7 Jrr, c17'4ietude--- /// w. /J :9. 6 .2". 4'e. O*FA i
<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 /> ,,r �/ ` 9 Newly Purchased
<br /> co'Id .10gr L/r/�1 /re'J)'/(�`ili'sr. 'Gl�7 "rich .9-,,i
<br /> Exempt Uses of Motor Vehicle: ,r-}t,� Are the motor vehicles used exclusively
<br /> El AgriculturalMorticultral ❑Educational I xl Religious 0 Charitable [J Cemetery as indicated?
<br /> Give detailed description of use,including an explanation it multiple use classifications exist: dirl YES ID NO
<br /> L-/e "fx /--4 fr. .- IC' c
<br /> A'111 ....4C -- t2 cn? cedv1 '
<br /> //, r,/, C. c r v: f.,ed. Te,rc [
<br /> c31 �- ti./K, c,f /_,,,r 7r fe ,. 2* If No,give percentage of exempt use:
<br /> flee. .r r-�Tl. ✓ %
<br /> 4'
<br /> Under penalties of law,I declare mall 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 nol discriminate
<br /> in membership or employment based on ,color,or national origin.
<br /> heel AuthorizetSgnataee"- d This Date/`/d /V
<br /> L FOR COUNTY TREASURER RECOMMENDATION
<br /> X
<br /> APPROVAL RECEIVED -tpnyV /2-e-11"-. 4:65:5".. 77-soa-
<br /> p DISAPPROVAL
<br /> NOV 2 4 2014 /Sgnatare ol County aure Date
<br /> /S
<br /> HALLeoutinv FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> TREASURERS OFFICE
<br /> GRAND ISLAND.NEBRASKA
<br /> APPROVAL CONMENTS:
<br /> El DISAPPROVAL
<br /> i
<br /> A_ . r _/3 5
<br /> prized Signatu._ Date
<br /> Nebraska Department of Revenue rwhorkad by Neb.Rem Stat.§§77-202(1)(e)and(d),and 60.3,186,and 80-3,189
<br /> 96-253-2008 Rev.8-2011 Supersedes 96-253.2006 Rw.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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