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or,�1 <br /> ev-t --..— Application for Exemption FORM <br /> Nebraska Ds Wnmenl et <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> -' r •Read Instructions on reverse side. <br /> Applicants Name Type of Ownership <br /> I GREAT PLAINS ANNUAL CONFERENCE OF THE UNITED METHODIST CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2418 N WEBB RD STE 1 PO BOX 5048 HALL Ei Other(spaalyl, <br /> City Slate Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tate Name.Address.City.Slate,Zip Code <br /> nAW)2 C5 04k0 04 13n-e-11 Pa 5(. 4.17,To <A. k.4 44.6 64 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> I it Newly Purchased <br /> VON b A too y a.I? y n4 L RE.-N.?5j2`JC009obo <br /> Exempt Uses at Motor Vehicle: Ate the motor vehicles used exclusively <br /> 0 AgriconoraVHodrcultwal O Educational 11)Religious 0 Charitable El Cemetery as indicated? <br /> Give detailed desodplion of use.including an explanation it multiple Use classifications exist: Kl YES ONO <br /> 5upOaVt51o1J OF ii Uutrct fl erNo ibr CUv c icS <br /> R/V o MCIR PAM PS <br /> II WO percentage of exempt use: <br /> Qa-r916-4A N neS-sale-VII <br /> Under declare a of law.I declare that I have examined this application and that it is,to the best of my knowledge and bevel.true,compete,and Coned.I <br /> also dclar hall am duly authorized to sign this exemption application,and Ihal the organization owning the above-listed property does not discriminate <br /> in membership or employment sed on ce,CMRG or national origin. <br /> sign gay t.1.---- /.r____ __ 4- b) -11 <br /> here 'Auhomad Signal% Tale Date <br /> i l {RjFOR COUNTYTREASURER RECOMMENDATION yI / 77- <br /> �.PPROV • ECEIVE•� COMM. TS: ^ 4� e a <br /> QDISAPP••VAL NOV 1 ? 2014 <br /> • 5i /,7-/b <br /> Signalure of County Treasurer Date <br /> TREASURERS QFFIChOR COU TY BOARD OF EQUALIZATION USE ONLY <br /> I'1 <br /> c- • '• NEBRASKA . <br /> APPROVAL COMMENTS: <br /> 0 DISAPPROVAL r <br /> AI tit; Ft <br /> •"'o zed Si, lure Date <br /> Neteasra Department al Revenue Authorteed by Neb.Rev.Slat g§Ty302(1)(c)and(d),and e0-3.1135,and goatee <br /> 96253-2006 Rw.5-2011 Supersedes 96-255-2006 Rev.6-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />• <br />