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2D l5 <br /> avin---4. - Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To baffled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> MINISTERIO DIOS ESAMOR ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 423 W THIRD ST HALL ❑Other(specdy): <br /> City Stale 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,Zip Code <br /> s1yr - MQWD Garcia. 1592 f la99c gave GJanel Islarvf Ne Cog D I <br /> DESCRIPTION OF THE MOTOR VEHICLES <br />• <br />' •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make I Model Year Botlyrype 1 Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> toY0774 70o7 5PORt VAN 5TD2K23CI IS 02'(t67 _ <br /> I <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturauHora¢eturel ❑Educational litg.eligious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple 'PAVES le use classifications exist: ES ❑NO <br /> -1 rov i de 4-rctnspof aim DP- ktml Ii - w t-Rno "' If No,give percentage of exempt use: <br /> Vdnirtes -VD and ere c-kurck fir weefcty <br /> vices, <br /> Under penalties of law,I de.- :th -examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare than am dui. - ,ri -d to sig this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership orempl• ,--,ed on re.: color,or national origin. <br /> sign 4 dr1 <br /> here Ate'` __ Voshr <br /> Authorized S"parr Title Date <br /> T��� FOR COUNTY TREASURER RECOMMENDATION '/ r <br /> PPROVAL RECEIVEDCOMME CS: 't� 1#42 � , 4 -77-...9e0.2- <br /> ❑DISAPPROVAL <br /> NOV i 7 2014 ..e `.aaJz / /. <br /> � <br /> Signature of unly Treasurer Date <br /> Malt Awn" FOR COUI9TY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> ,LQPPROVAL k,VmrvrcNTS: <br /> ❑DISAPPROVAL -.=., A <br /> la tillreAr <br /> nY. • ,. •IT: u 'f D to <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d).and 663,185.and 60-3,189 <br /> 96-253-2006 Rev.6-2011 Sgersedes 98-253-2008 Rev.5-2008 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />