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<br /> aleteet---z— Application for Exemption 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 /> ABUNDANT LIFE CHRISTIAN CENTER ®Nonprofit
<br /> Street or Other Mailing Address
<br /> 9 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 pp 1 t� Name,Address,City,State,Zip Code (� 1 f: s,
<br /> 51zn:dr V. -23.4 ice5.115.4 35o t. Wfut INS( -111 Qe.LjeJ3. Ra ctra�- s bA& a VscCpi
<br /> a tf - A, iosl.or ,_,.a.x, et_ - tt3 u9. u ta.� I • '.1,0
<br /> it. i. ♦ S. .a,. k- 1 't. 1 't • r _ (DCVO
<br /> ' sac t a Pak( Gmi Jitat�akvsaar - 30aao to Hts5. C:,-a, xs , Nr &Nt)3
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> *Attach an additional sheet,if necessary.
<br /> Motor Vehicle Make Model Year BodyType Vehicle ID Number Registration Date or Date of Acquisition,
<br /> If Newly Purchased
<br /> H&H 2015 7X16 ENCLOSED TRLR 533TC1621FC243680
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricultural/Horticultural ❑Educational 'W Religious ®Charitable ❑Cemetery as indicated?
<br /> [�7
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO
<br /> 'ttt c i5 (44 {c( ( urN1 exit ()NISEc15 Q,.k c, by uac cLcAt. ms ,oet\
<br /> as 90.4-4:04-;m3 g9.kr. ok%ec co,tmr 'L(At .-cc3uAkYw�:an 14 eJOn43 , Su[in as
<br /> If No,give percentage of exempt use:
<br /> Sr,6--,4—x. k(t4, kr 4xt4aor oa' u0 co- gk..0.1 -4. -Gout 6, beep u4 %
<br /> ca- duArck b,„ .. p0.21441-5 044 1sDo&3 ANteADAs ow.,cie cula QJ,1/44Q
<br /> of Ce>i■rtLkv..
<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 property does not discriminate
<br /> in mar ership• mph based on race,color,or national origin.
<br /> sign pl AI Sig
<br /> here Aut rued Sig Title Pam- i4-41-t�
<br /> Date
<br /> r�yr,- S r�s I
<br /> FOR COUNTY TREASURER RECOMMENDATION / ^�
<br /> g1. nrPROVAL 1 C CEJVEY MMtNY3: 41-$: ' ~I�-° cY�--
<br /> ❑DISAPPROVAL
<br /> NOV 1 7 2016 / � -> /ac,7d-/G
<br /> Signatur Co ty Treasurer Date
<br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> HALL COUNTY
<br /> TREASURERS OFFICE
<br /> ❑APPROVAL GRAND ISLAND NEB
<br /> ❑DISAPPROVAL l 7 el
<br /> l orized gneture Dale
<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 /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS,
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