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9,6 15 <br /> Nebraska Department of <br /> 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 side. <br /> Applicants Name Type of Ownership <br /> IGELSIA DE DIOS EBENEZER ® Nonprofit <br /> Street or Other Mailing Address smo 2- C.3-,Jai „Pe-. County Corporation <br /> 722 N BRQADWEE AVE PO BOX 486 HALL <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> -rise Name,Address,City,State,Zip C•.e <br /> r <br /> .r�t•att•Sta a / ' 'I • , • b _ _ /' //,, <br /> i i f � ZO- <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 /> if Newly Purchased <br /> CD 0.0Ci: try, van 63 sty 25cN535-2-QVKf LJ7r8 <br /> glue b:rd 2000 Fu S,3 7'C 2o° /f3114KrsH3yrOfl 153" <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> meted? <br /> Give detailed description o use,including an ex lanation iitt/mulultip a use�classificatitionnss ist: YES ❑NO <br /> ��ia�c( ( l' " �� ✓< Y� " <br /> If No,give percentage of exempt use: <br /> U>6.- i 1 ivy <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 lam 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 o ce,color,or national origin. / <br /> sign <-ee ----- 2.C__ c?s /zl/i/i, <br /> here ►Authorized Signature Titi Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> [ PROVAL RECEIVEOMENTS: t f E " A ��S -' 77r.17c— <br /> ❑DISAPPROVAL <br /> DEC 1 1 2014 I� ,�j° 42- /-8 ' <br /> -i•5 <br /> Signature at County Treasurer Dale <br /> HALL COUNF9R COUNTY BOARD OF EQUALIZATION USE ONLY <br /> I RtASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMON IS: <br /> ❑DISAPPROVAL �� <br /> / kar.. �1 45 <br /> ''prized nn- u' Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.If 77-202(1)(c)and(d).and 60-3,185,and 50-3,189 <br /> 96-253-2008 Rea.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />