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Nebraska Department of <br /> Application for Exemption �U t FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 457 <br /> •Read instructions on reverse side. <br /> - <br /> Applicant's Name Type of Ownership <br /> ABUNDANT LIFE CHRISTIAN CENTER ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3411 W FAIDLEY AVE HALL <br /> _ ❑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,State,Zip Code <br /> PPESI,EAir elA500 R. tc,RR/A/Ef2 7/7 REDijptD GRaup SstAN1J, NE 68803 <br /> €ASt ,RELC k'eAf teRRREAJ 31/45 LQ. STATE Li GRAND,37-51112 A I E 6fo3 <br /> care eTAR4' NANCY ✓ANCE 30673. WEI,Et GQAALp15LRlvP, A<E G SPol <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> i 1 Registration Date or <br /> Motor Veiilicie Make 6foueilear LimyType Vehicle ID Number' Date of Acquisition, <br /> if Newly Purchased <br /> Cffc/fCLCT /QQ0 1560 Sa%3tiQoaj /6,VEV/&11(y<F1187/C <br /> • <br /> 114 H • 02015 7x/le EAletoSeft72A11Ee 533-T c f 602/Fag'/3v8D _ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ®Religious El Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: J ®YES ❑NO <br /> This lit rlet- &j;// be a 6CCL -lc ri:714 crf 3itfyoifes a-vid If No,give percentage of exempt use: <br /> 6, 4/�'i92irfti- -IC avid -treril dof -r/- -faer /ih(E` canal <br /> cef/t`r lies, 1.f toi� �c'/SG be used -/C rises, /Yl <br /> 2. rrli ittelhfd oaFAracAps umti even f5 . <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.l <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 mem,- ip o t•loyment based on race,color,or national origin. <br /> At <br /> e <br /> i <br /> sign . Notha ■ frees Ckcivc Na '3 6 <br /> here i1 Au ri -d Sign Lure )& . <br /> ie Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> L2'APPROVAL RECEIVED COMMENTS: ��� A4-2 al- <br /> - # T `�� <br /> 0 DISAPPROVAL EP1 6. <br /> NOV 1 b 2015 C a n S <br /> Signature of County Treasurer • Date <br /> HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> tNt/tUrxtrco OrFtCE — <br /> GRAND ISLAND,NEBRASKA <br /> 'C 'APPROVAL COMMENTS: <br /> fl DISAPPROVAL <br /> Aare ze•Sig a l}-7 Dat <br /> Nebraska Department of Revenue Authorized by Ned Rev.Stat.§4 77-202(1)(c)and(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. <br />