Laserfiche WebLink
aggvn---z— Application for Exemption FORM <br /> Nebraska Department A <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 /> GRAND ISLAND EVANGELICAL FREE CHURCH ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2609 S BLAINE ST HALL El 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 />• <br /> C-\kEt C a r.._, L-t. 4-.ti cLVa_ 2 7 e . -..-L vl r ('o rr. —.t. -S.,,..\n —,:cal ‘11S--- ir`6 0\ <br /> '7 A.e. Ste_.,--\tF, 2w; ..c------k•-- Cl-r c_�a_s.'A K_,:>,t te '•kfic-3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make I ModelYear I BodyType Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> Cz orA, co 3S X.`•---C - `�,�e-- c'v '4 n_� -t tss S Z,i-S O acaA-11%t <br /> Fo,� Sobw% cc‘. - -1-JVy 1=..c<-...c- Cie.n 1c6SS3a1=i`kVi -A3-134 <br /> e c (1),..rJc....s G Sc c A SC'.S C-rk S prt t)a... 3-Co J • c,39 e13exl VO`ky} o <br /> j'-e-re>t 42Wxr 2Lro3 J.ti A2e '-‘cv AFr yr.Y t-,- .5 0153••_;e q-1.34 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> fl Agricultural/Herticultural El Educational [Religious III Charitable I:Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: 2YES D NO <br /> l'`---€,----,€.;Q"f If No,give percentage of exempt use: <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 properly does not discriminate <br /> in membership or employment based on race,color,or national origin. r .+ <br /> 1 Cr- <br /> Sign : va\��as'v'1 <br /> here*AumtinzedSignature - Title Date <br /> FOR COUNTYTRE�AS, e„s•°z' <br /> UyRER RECOMMENDATION <br /> APPROVAL RECEIVED COLIMENTS: fi Alt 447 At 7 7--?02 <br /> ❑DISAPPROVAL <br /> DEC 5 2014 �a& 8-/r <br /> 10-Signature of my Treasurer Date <br /> I HID t CM MTV FOR UNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL MENTS: <br /> Li DISAPPROVAL �,, // C• <br /> "AMC 14 4 ,./• Date/g� L <br /> lthorized '•n.'re <br /> • db Stat. 77-202(1)(e)and and 60-3185 and 603189 <br /> 9625-206partmwx11 Supersedes Authorized by Rev. §§ (d), <br /> 96-253-2006 Rev.8-2011 SuPe,setles 96'�` -2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />