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IL go i!5 <br /> .ist%t_r_-- Application for Exemption FORM <br /> Nebraska 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 /> NEBRASKA DISTRICT COUNCIL OF THE ASSEMBLIES OF GOD T. Nonprofit <br /> Street or either Mailing Address County Corporation <br /> 1503 INSECOND ST PO BOX 1965 HALL <br /> ❑Other(specity): <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 /> Title Name,Address,City,State,Zip Code <br /> PRcs..A.e- gotoext W ir.e.- ac-r E. 541 • St. Keate..Ney NE to8B47 <br /> $ct.o .twa-t /TAe.-s1.2c2 -reR-y 82ok--r (o`gc0 Sx5 love Lanc 1_tr■ccln N F. 6,3Soy- . <br /> Qu R4_-L,toR Go -'.t Hoff Sioq !`ivn keit A idle OR, Pap,it`ch4 NE (,t133 <br /> D.2ecto!Z S-evc. WA.RRJnea 31t(( W Fatale fad zn,.`F.LStakd.NF 6,gg03 . <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 /> it Newly Purchased <br /> Seec.,:tt= sad Skee.i tZ 6 JeS'c&c c <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturelMonicutt �,--,(ural ❑Educational pal Religious ❑Charitable ❑Cemetery as ind sated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: NR(YES ❑NO <br /> jhest ucktck (Ake used to cave Ipa5+0Pc.( Ccc✓Le '{V OUak MoRe <br /> Rte c.k�RC�` c„wd mo.ee t14/.v <br /> c1 Mtn`� �c I n II No,give percentage of exempt use: <br /> GA-GAL vff )1/41 eb2c.sKc... ( Ina_/ ai1/44.._ a(co ticsd `Ft) Coo,ed,.wfe <br /> Qkd- Amp AZwle...—t O0 2 I7is-lR- t 6 u ew7Sr (awyct COrIVC,fi�Ac , <br /> 2 ink LVJ.xRS, etc_ Co„.4-e....4_ Naw e • SOAK tr.---P_,,,.c;cc o 3ESi-j-I2 4"-1 <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 property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign , .f P.t;LN4.0. ... V r/—/ z_/54 <br /> / . - <br /> Authorized i na• '- Title Date <br /> here g <br /> ee <br /> FOR COUNTY TREASURER RECOMMENDATION J <br /> 121-074 F OVAL RECEIVED COMMENTS: -6/e "yr" ,.//20s Ir77 ace,...2, <br /> ❑DISAPPROVAL <br /> NOV 1 4 2014 p��gq3/1‘05." ia /,7-/-5_' <br /> • Signature of County Treasurer Date <br /> HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL r <br /> iA ilia$irn —� —15 <br /> Ay'o zed Sig atu - . / Date <br /> Nebraska Depanment of Revenue Authorized by Neb Rev.Stat.§§77-202(t)(c)and(d).and 80-3,185,and 60-3.189 <br /> 96-253-2006 Rev.8.20t1 Supersedes 96-253-206 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />