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aot.b <br /> ..„„_ 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 /> Applicants Name Type of Ownership <br /> THIRD CITY CHRISTIAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 4100 W 13TH ST HALL ❑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 /> The Name,Address,City,State,Zip Code <br /> da_'r — C. Gctdes _4-. 001. .I L 0 . f - „k ::• <br /> Ileas-ueor ri • Mustiont 332 • ••- .. '�rt Its. sbrdi rUc G$g$a <br /> (2tt.k*men X40 4, nbrt& R�I,Gaf l �slaytdi ►Jr; (a8€D� <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,It necessary. <br /> Registration Date or <br /> Motorvehlcle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> It Newly Purchased <br /> o •'0 • _ s:s ,1-0314& • • <br /> Cord-eC_ oi) IleVai1 - 'e 06L ! 12c4o <br /> i:+6,4"II- i AL-i G - I =4 aWIRrt:t. <br /> _1_ A d 'r �t spas 1.8'.' 2 comic� _ <br /> me Ca.tana -..ry r ) E i''11 LIMIME :Ylf A1EA 019,1/ <br /> Ex, Are the mato vehicles useo eXClusrvenr <br /> Li Agricuilu IMMOr§cultural L Educational I yReligious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: /`,,,,,yyy��� 'YES NO <br /> 110).e., -6 (� act i..nainla, (AG�� -6- n�c (L C1 pr€036 If No,give percentage of exempt use: <br /> V/tA7 � T {I/ % <br /> `he—3 fcs alai son Mai It U ■ -ox ialul lcet2_ iftl i Piet nes <br /> Wit- l�litaci-v\ Chri lChurch <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 dedare 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 mployment based on race,color,or national origin. <br /> sign e-cial,— k1-or chairman ///9--i y <br /> here 10.Authorized Signatu Toe Dale <br /> FOR COUNTY TREASURER RECOMMENDATION I <br /> L.j'APPPOVAL RECEIVED COMMENTS: /Ott, N. S ,et 77 4p. <br /> ❑DISAPPROVAL <br /> Nov 2 0 2014 e2enr ieao,,{2" /-9-ice <br /> • Signature of County Treasurer Date <br /> TPE RE Pt FOR ;OUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND.NEBRASKA <br /> ,(APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL <br /> / /®re /—/. --/-5 <br /> o zed 49n...re r . Date <br /> Nebraska Department N Revenue Authorized by Neb.Rev.Stab.§§77-202(1)(c)and(d).and 60-9,185,and 603,189 <br /> 96-2532006 Rev.6-2011 Stpersedes 96-2532006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />