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Nebr W Oepanmenlof Application for Exemption FORM <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 /> GREA 1 PLAMS AMAIIAL , wNFeRENC6 of TN6 UN I rED MErHobisT C N URCH F. Nonprofit <br /> Street or O,tthher Mailing Address T t� C �(e County Corporation <br /> zsil WEa8 RP. .z•r€ I , PO�\L >6 f 2 HA Li— ❑Other(spedfy): <br /> City State Zip Code State Where Incorporated <br /> GRMN? ISLAND, N E . 44201 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Lp Code <br /> EHAIR PER5oN Tom EMERTON Pa.3ox +Ea CAIRof Nk . /688141 <br /> SECRE-TMRy dealt- 6ATFLY 9359 WALMC& IT. OW A4D PARK, ICS febj/2 <br /> VME - eEAh2 PERsoM LoYb NAMRICk 16323 W ALAAto 5I, fuICHI?A) ti. (o721z <br /> _ DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehkle Make ModelYear BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> #aNDA 7_0 lb ACCoRD IHaeR2F30EA01,124o of-040-20143 <br /> Exempt Uses of MotorVehide: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational ®Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation R multiple use classifications exist: cg YES 0 N <br /> 1>srRICT OFFICE suPL^RVISIOA of 71 CHURCHES AND <br /> CAIN S CONFERENCE D F If No,give percentage of exempt use: <br /> PAbToRS FoR ?'BEEnr P loo % <br /> ?HE UNI?L-P McT4i aISr CttuReti - <br />• <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 properly does not discriminate <br /> in membership or employment based on race,color,or national origin. n <br /> Sign `btrrRiet JuPFRIN?ENDSr o • (Z-xcl4 <br /> here ,Au 11 ignnatuure$� T TNe Date <br /> �°i�i, FOR COUNTYTREAS�UyREERRRECOOMMM ENDATION �i <br /> �APPROVPL RECEIVED COMNENTS: L! l. )4 ��� i ?'57°42' <br /> ❑DISAPPROVAL <br /> APR 1 2 2U1b -lC—/-_ /l <br /> s Treasurer Date <br /> I ALL COUNTY <br /> TREASURERS oFriceoR COL NTY BOARD OF EQUALIZATION USE ONLY <br /> '''ppper� GRAND ISLAND,NhI*RA A <br /> SK <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL A / i / <br /> , -gg!.m.1 Date <br /> .F <br /> Nebraska Department of Revenue ANhoreed by Nab Rev.Slat§§77-202(1)(c)and(d).and 60-3,185,and 80-3,189 <br /> 96.253-2006 Rev 8-2011 axperestles 98-2532006 Rev.52009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />