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cre-1--z- Application for Exemptions I (- 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 /> DONIPHAN UNITED METHODIST CHURCH <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> PO BOX 188 HALL <br /> • ❑Other(specify): <br /> City State ZIP Code State Where Incorporated <br /> DONIPHAN NE 68832 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Chair of Admin Team laurie Lueck 4030 W RnspdalP Rd flnniphan NF RRR22 <br /> Chair of Trustees Myron LautenschlagPr 57E7 W Binfield 11d fnniphan NF RRR32 <br /> Church Treasurer Mark Haskins 240 W- flinfield Rd Ooniphaa NF 68837 <br /> Lay Leader Scott Wilting 206_E Plum_St .nniphan NF 68812 <br /> DESCRIPTION OFTHE 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 /> Chevy 2001 Express Van 1GAH09J1911205780 2-3-15 <br /> Blue Bird 1 1999 Bus 1G>EKR328XX3304774 10-1-14 <br /> Blue Bird 1999 Bus 1GBKP32R9X3304748 10-1-14 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> El AgriculturatHorticuitural ❑ Educational ®Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if muitple use classifications exist: ®YES EI NO <br /> To transport dhildren to and from activities. <br /> If No,give percentage of exempt use: <br /> To transport youth group to and from activities. <br /> For transportation to church activities. <br /> Contact name: Rev. Kelly Karges 402-845-2761 <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 AtAr A i` (e.>4+ /I— i 1s <br /> here Authorized Signature Title Date <br /> f Ir�lFrF�i^ FOR COUNTY TREASURER RECOMMENDATION <br /> E tAPPROVAL[ i t Y I.xy COM RENTS: ::. ;rc• �. Lr-I_- ✓ �� �%' 4>C-e42 - <br /> DISAPPROkAL 3 <br /> I <br /> Ot Signature of County Treasurer Date <br /> HALL COUNTY _ <br /> FOR CC LINTY BOARD OF EQUALIZATION USE ONLY <br /> 9`RE• umrNS ir!-Il.rt <br /> GRAND;SLAND,NEBRASKA <br /> )4 APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL <br /> swear <br /> ri�r Infiriteir m <br /> A oozed Si;natu .� war Date ate <br /> T <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rey 8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />