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it^---e__ Application for Exemption of 0/ (p 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 /> MINISTERIO DIOS ESAMOR ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 423 W THIRD ST HALL <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tale Name,Address,City,State,Zip Code <br /> CP re s i A pv■k. 1 - say,-}-oc B . ()Roonez /Qb7 Al. 1,,lshton }oi 5t ME te gRSV <br /> C t to d. Pas-1-o r• <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 It)Number Date of Acquisition, <br /> it Newly Purchased <br /> B the IC lei q5 / FcnE)rr, l64HpcaLzawUe727a <br /> Exempt Uses of Motor Vehicle: h� Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural ❑Educational igl Religious ❑Chardable ❑cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: gl YES ❑NO <br /> (O OV e r c ee° -}-11 e. Qin u r ch t s min(S-t-ry If No,give percentage of exempt use: <br /> q <br /> I i'1 .. 1 a <br /> Je—brska . <br /> Under penalties of law.I declare that I have examined this application and that it is,to the best of my knowledge and befef,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 mem•�or employment based on race,color,or national origin. <br /> here ► 1r , , fLVii- cts >/ e,i �s �,y1 %�, 2p / IS <br /> Authori i::• Y Td Date <br /> FOR AP COUNTY TREASURER RECOMMENDATION <br /> PROVAL R CEIVED COMM=NTS: ^� ' /ali1 f l tie 77-,90.2_, <br /> ❑ DISAPPROVAL r� <br /> DEC 3 0 2095 �� nty�j ��-2 l f�/‘ <br /> Signature u Treasurer Date <br /> HALL CouN tMrepR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND,NEBRASKA <br /> yli APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> draWrairnri <br /> Ar orized Si _ •e, Da <br /> Nebraska Department of Revenue Authorized by Neil Rev.Slat§§n-202(7)(c)and(d),and 80.3,185,and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FORYOUR RECORDS. <br />