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��-Z Application for Exemption 7040 FORM <br /> Nebraska Department of <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 /> Applicant's Name Type of Ownership <br /> THIRD CITY CHRISTIAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 4100 W 13TH ST HALL ❑Other(specify): <br /> City Slate 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 /> Eider chairman larr) c.&prates125ib icw . Gran4Yslar4Ne 68801 <br /> treas&-uw ill Davytei 843-7 W N occiri verpcl,thl0od River volg3 <br /> 5e ra-ari frrif Ru}1 rr13n 12b40 tJ. I4orthP�y 6( nJIstarcl1 Kke (agate <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 I Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Ft R© 1990 taus ipar- 3151-13►1ALlioa3 <br /> R)Rb--c.contlincyctan 2003 Van 1FDf4TfyReWAi2c40 <br /> argil 1991 13(45 L4.vsiAePivA016.028 <br /> ue hid 1998 gu 2W <br /> y 143AAGIC5l4FO-7-7702. <br /> ill 5a41artra 6)35or) 2-aDo _CukAt..n Sus I6aSS'G3W11111c9(04 <br /> Exempt Uses of Motor Vehicle: rH Are the motor vehicles used exclusively <br /> ❑Agriculturay le <br /> Honiculturat ❑Educational I a Religious ❑Charaade ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: (7 1 'ES ❑NO <br /> -II ve4UCes ace_ mainly U.s� —Pave nor�p(o i'�- If No,give percentage of exempt use: <br /> 6cnnec-4- pc1� 'arn 1 hovJev-eii -{-h-c ail imay be % <br /> lASad -ft(' nu I+ ele VYl (n; s-fvi es a1-- IlkirA <br /> C-111 Ch(C5-hOn alA_Arcin <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 awning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign >a� ei�eY r✓ha�✓mav� //-/?-/ 5 <br /> here 'Authorized S store Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> PROVAI RECEIVED COM MENTS: �/244-1 Al-.957 4- .77— t2 - <br /> ❑DISAPPROVAL _ 0 0 <br /> NOV 2 3 201 [- � ' arAL�e <br /> it Signature of CountyTreasurer Date <br /> HALL COUN t r <br /> T OR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> a6 n cwt 1RFRC nFFI/:Lf <br /> ,,,,rrrrhhhh <br /> GRAND ISLAND NEBRASKA <br /> y3APPROVAL COMMENTS: <br /> ❑DISAPPROVAL w � �� <br /> ! /ii i - <br /> .$ dzed `•na C ' i e- - <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 /> 98-253-2006 Rev 8-2011 Supersedes 98-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />