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(2,N5 <br /> -- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE V UE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> 1, •To be filed with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> FIRST PRESBYTERIAN CHURCH ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2103 W ANNA ST HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ten _.z.r- -28 5 1:,/A ,14„:„. �S Sl t a.5 I ' ,P/o/ <br /> / i ,. - Soo L.A _,..�..y^._-lam / .. / <br /> �:.� _,,...u_, e2ao ` ".�.- :. s • io <br /> / of <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear I Body Type Vehicle ID Number Date of Acquteition, <br /> If Newly Purchased <br /> rte4) q / 2/) g-4O7 i '9 9 -, i.-in.-,,.w 16 A Al as 9,7-5-x A4a 544 9 <br /> _a.� ' • At . - / F - /JD- <br /> 6r A' ./C- o2000 r"yv/� /GKa/77 19W XYd3s-v3 671 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgrieulturalMorticultural E]Educational Religious ❑Charitable ❑Cemetery as indi a ed?tizj <br /> Give detailed description of use,includiingg an,expllanation if multiple use classifications exist: OYES ❑NO <br /> �(� �e(A-pt/ �( C -- --73. � If No,give percemege of exempt use: <br /> (//l � �r✓Gd % <br /> Under penalties of law,I declare that I have examined this applica' n a 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 eppli tion,and that the organization owning the above-listed property does not discriminate <br /> in mem ip or employment based on race,color,or national origin. / <br /> sign ) (iii(-e- '9 , u£iz ,� /x2-0)-i y=/- <br /> here honzed Signature The Date <br /> I FOR COUNTY TREASURER RECOMMENDATION <br /> a-O-PROVAL RECEIVE ve "n5 /- 42q5: 444-77— O <br /> ❑DISAPPROWL <br /> DEC 3 2014 af(�o,</Z /-cr-/.5' <br /> 111.Signature County Treasurer Date <br /> HALL COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> 91APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Si <br /> A i orized 7 tire' Pi/ Date <br /> Nebraska Department ot Revenue Aunwreed by Neb.Rev.Static 77-202(1)(x)and(d)•and 80-8,185,and 109,189 <br /> 96-2532008 Rev.8-2011 Supersedes 98-2532008 Re'.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />