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aQf7 <br /> Nae ekaPep a— Application for Exemption FORM <br /> nt 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%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 /> 0 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 /> SeN;x P. -14 Re f <br /> 5.14-4 •ado.5a& 00414.ac --pi ReLwea& Ro■ c'R..J. S4ANa NE (p 3 <br /> • t..:.. c( - • l'Nroty( ..,.ILL. - - $\} _ Y a ). , '•(603 <br /> «a r e t. ..a,. • k 'I, t ;. '1. • •r T: . (ottO3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModeiYear aodyType Vehicle ID Number 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 /> ❑AgriculturaVHoracultural ❑Educational tin]Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: RYES ❑NO <br /> -1-Wei 15 v6ea Qr telex ut..l1 e ts& Qicljeas Or oi, by we c6usA• as oe <br /> U 1 L_twL 1 If No,give percentage of exempt use: <br /> Cl9 rti—it21 ;N VO'\ Oc e{ IpD40`1Y'Jat∎ -Ct^J aiS4a Rtl 13 Aa■ OS <br /> & c „fc h 6ku1ii5 po3u,}s ot.a saa,4.3 ,okb:d�+as \v-�`ae cu. cLawde <br /> C <br /> 5�� <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 me ershi• • .male based on race,color,or national origin. <br /> sign ,��J! i� kskw Pe <br /> ihLl 1p <br /> here ,Aut rized Sig a Date <br /> ��--�,, FOR COUNTY TREASURER RECOMMENDATION <br /> AL <br /> S:5.Rya•CEI tEi1bMMENTS: iC��!��1.in2�'z „4-24.4—) /!/ $ S "77 GOc <br /> ❑DISAPPROVAL ill+.t�••alll-`ILs lY( U � �,�, <br /> NOV 1 7 2016 �� - e(� j AP a,-/C- <br /> Sgnatu o C ty Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> FALL COUNTY <br /> TREASURERS OFFICE <br /> ❑APPROVAL , GRAND ISLAN3,NEBR Ccnt: <br /> ❑DISAPPROVAL <br /> .l air.. % //,/I .f 17,00-97 <br /> 'u •rized ignature Date* <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stal.§§P-202(1)(c)and(d),and 60-3,185,and 50-3,199 <br /> 98.253-2006 Rev.6-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />