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, 2D15 <br /> N Departmen 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 /> Applicant's Name Type of Ownership <br /> ST. STEPHEN'S EPISCOPAL CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 422 W. 2ND STREET HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title I Name,Address,City,State,Zip Code <br /> Rector The Rev.Robert Lewis:2642 Carleton Avenue#8 Grand Island,NE 68803 <br /> Rector's Warden Byron Moore:2808 Lakewood Circle Grand Island,NE 68801 <br /> People's Warden Kathy Stoddard:1607 S.Harrison Street Grand Island,NE 68803 <br /> Financial Secretary/Treasurer Leslie Lewis 4239 New York Avenue Grand Island,NE 68803 <br />• <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> Ford-Taurus 2007 4-Door Sedan 1 FAFP53UX7A148569 08/15/2008 <br />• <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ®Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ONO <br /> Transportation for the Rector, Parish Staff and or its members in order to share the gospel, If No,give percentage of exempt use: <br /> provide outreach and ministry to all persons, including shut-ins, and the needy of Grand <br /> Island and beyond.Also used for travel to and from services, residences and church <br /> meetings, conferences, retreats and Youth events such as summer camp. <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 membershirr employment based on race,color,or rtpJional origin. <br /> Slgn; (I, t Financial Secretary/Treasurer 12/11/2014 <br /> here Au stied id S ure Title Date <br /> -- / FOR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL -- RECEIr ' ' ' S <br /> ❑DISAPPROVAL �J ` <br /> DEC 1 2 2014 EJfi.°Eo-=4- /9-�� <br /> •i► ignature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> tREASUREERS OFFICE <br /> ip,4PPROVAL ORANDjSLAND.NM/WU .. <br /> ❑DISAPPROVAL / a <br /> / a�/����4i � <br /> /i ')-15 <br /> A orized?!Au r: r <br /> Dale <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and Id),and 60-3,165,and 613-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />