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Nebraska�^ z o Application for Exemption o / ( FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations' 457 <br /> •To be tiled with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> GRAND ISLAND EVANGELICAL FREE CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2609 S BLAINE 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 /> Title Name,Address,City.Slate,Zip Code <br /> f 1.4ee C)&0/tanl 1 INN 10 4450,1,3S18 MtnAJwl&lc.CIIrf 6r�Ifs(aaI NE 4.'903 <br /> 1tcp. 1 ensr2 vv ' Jerry Alo✓a knterK:i 4066 L:IITe Dr, 6.-Aal Island Nr 1l23 <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 /> foci) Mho X1--1 es-Ripon 2011 vtLn 1 3$►-58P8 t'61%1 <br /> col . O is Los t 0* ontaan 1 31 L2 1W, 1313_ <br /> FiMt; Szvae& Fa3rt IgA ex4- 6jbrt Wise) IW.1.1 3%?,3INVAL <br /> 45i- 2Jar 20D IL4 1: -1r8 her LIK4UI,r.o Ic3jr10i4S3Q <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ["R Igious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: 26 0 N <br /> If No,give percentage of exempt use: <br /> 1h4Fla veoIe G1 r /VI-in 1 =1- eqw,p 11 ev�-k ' . <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. �q,_Oltt /in t (7� .30X -70 -I g 1 <br /> sign p4cia S1,i1au so.,_ u,hi Ktai Ett tt 9&r 11Ig l 6 <br /> here (1 Aignature Title Date <br /> RECEIVER FOR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL OMME VTS: 2;0' j ,—. #42' S//, l< , <br /> ❑DISAPPROVAL <br /> NOV 2 2015 °e• a <br /> i•Signature of County Treasurer Date <br /> TREASURERS OF Re t COUNTY BOARD OF EQUALIZATION USE ONLY <br /> 6 ,,r D <br /> 1 n i5inrau,IYtbnAbFA <br /> VC i APPROVAL COMMENTS: <br /> ///l DISAPPROVAL , / <br /> I. <br /> i;.�1/l,�_ ., . ,,./ / eit29p6 5 <br /> Au irized Sig atu . Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 80.3,185,and 60-5189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />