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s ate— Application for Exemption , ( / (c 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 /> 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 Other(specify): <br /> City Stale Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name.Address,City,State.Zip Code <br /> Ira,_ rG�• .w.a C _u- a .._a k 0 i l• C• , C. :_ <br /> .1��. r'r'�iT7- tJ ' • • - • .S • L • <br /> Plgir Re'a'm• !lt•DW.'_ <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 /> L)raa, � V c. @ attLRE141589Gw4bW <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> O AgdcuburalMOrticulturel ❑Educational 54 Religious El Charitable ❑Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: OYES 0 NO <br /> Gi _ - e bf I L • fi I IlA � C.{�Q� If No,give percentage of exempt use:ejil�J.ALJ„'`JL' Kl d/�/v.J . l 4k'r IA�.K9P'`-Ji.�•VV ��iX YS. 100 °/, <br /> Under penalties of law,I declare that 1 have examined this application and that it is,10 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 ( ..Y,ti.g,72 ,-,.4-Ani ��-5-is° <br /> here I Au' <br /> .ignature „Jr TICfe Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> yy}re *y E l fp�� I r.'' - z,. 1 <- sF-77. - C <br /> IS 'PPROVAL 1.61 i Ga mounts- •4- ' "L- /L' "=d''_ �3 'L.1. <br /> ,,.aI TN , <br /> []DISAPPROVAL � v . SEAL <br /> s SEAL '° <br /> ,,/ /Signature of County Treasurer Date <br /> TRE <br /> I PA`s.E RSlcp OUNT�BOARD OF EQUALIZATION USE ONLY <br /> 'A: is c �19LE <br /> GRAND i8L:+Nu. N_E RAt:,:rf <br /> gAPPROVAL COMMENTS: <br /> []DISAPPROVAL 12/,�� �� <br /> Au ignature f <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat§§77-202(1)(c)and(d),and 93-3.185,and 60-3,f89 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />