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soreet--z-- . Application for Exemption ((J ( V 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 /> PROPERTY ASSESSMENT •Read instructions on reverse side.
<br /> Applicant's Name Type of Ownership
<br /> FIRST PRESBYTERIAN CHURCH ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 2103 W ANNA ST HALL
<br /> ❑Other(specify):
<br /> City Stale Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68803 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City.State,Zip Code
<br /> j)(�',it..-i' �-/ 'yf%7; ALc .32 si S IGr&/GScr<.2_ /C'i �Nk.Nc;�.K-a7d. bcf 1..1(5-Li/
<br /> I/ A,A., ` >- _,.. , ,,,,7 gc ^36to 5,/ fit✓n. .eve-c 1//.E'c., .. /1Ylll x-ri .__.2iCQ�k I L.rA2/
<br /> r a 2 t'<e%e/ -f- Aid--_ -f < ./,-4- ,t. L2C 1 :. f -el' / ,,.- --d' - G... -c/
<br /> -C ,.,7. A ,�r , .»�- /i-,,, ;,t t a u 8' I," 4,6,-c c-r-a-ir- A' F-X_ CIS_c A a e a 6 c 7.
<br /> DESCRIPTI N 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 /> u-r. Q 9/5.1 4%x0 0c 7 /29 d l A u w� I LAH6 39 3-ax /6455hi cz
<br /> cc //t ;/6--e=c ,x4- U -i-' , iL A4,22/9as k- c S5 iir 7/
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑AgriculturaVHorticultural ❑Educational 9 .Religious ❑Charitable ❑Cemetery as nd sated?
<br /> Give detailed description of use,including an explanation 11 multiple use classifications exist: YES ❑NO
<br /> { L Tt��
<br /> '(�� �t.ff�.%r fi=t i� y{ - t/ If No,give percentage of exempt use:
<br /> 1/47 Under penalties of law,I declare that I have examined this application Land that it is,to the best of my knowledge and belief,true,complete,and correct.I
<br /> 2 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
<br /> t i ( zt � IS / i here n aure
<br /> ele Date
<br /> FOR COUNTY TREASURER RECOMMENDATION
<br /> n �? .. %.) �' � 77- ;7c-42_
<br /> APPROVAL RECEIVED COMNENTS: ��� � /1-2‘ �'a
<br /> a11.TeEr3G
<br /> ❑DISAPPROVAL -se l tt le Yn
<br /> a ! oS i5
<br /> /Signature of County Treasurer Dale
<br /> HALE COUNTYOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> TRFACI IR F9S n
<br /> GRAND ISLAND,NEBRASKA
<br /> VI APPROVAL COMMENTS:
<br /> o DISAPPROVAL /1 /°2l/ c Arra
<br /> A e•rized gna . ' Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.1,§77-202(1)(c)end(d),and 60-3.185,and 60-3,189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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