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aNjt) /7 <br /> Nebraska 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 <br /> Pp Type of Ownership <br /> DONIPHAN UNITED METHODIST CHURCH <br /> ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 303 N 6TH ST PO BOX 188 HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> DONIPHAN NE 68832 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> CIMA,R, 4OMIN COAtmirzEE LAURIE Luectc No30 ROSED4&E RD, DOiliPN44 NE 6g832_ <br /> SECRETARY DEC 14EDa1r4141 3'l4 SUNSET DR, DON1P/f96l,NE 6g$32, <br /> TREASuwe,2 MARK HASI:INS 240 8JNF/ELD RD DoNIPMAA& WE 65832 <br /> CNAII , TRUSTEES MYRON LAUTENSCMLQGETR 5767 3,NFIELP RD, DOMIPF44+4 tJE 68832 <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 ID Number Date of Acquisition, <br /> If Newly Purchased <br /> CHEW 2001 EXPRESS VAN(BUS) 1GAHG39R911205760 <br /> BLUE BIRD 1999 BUS 1GBKP32RXX3304774 <br /> BLUE BIRD 1999 BUS 1GBKP32R9X3304748 <br /> —s <br /> Exempt Uses of Motor Vehicle: g Are the motor vehicles used exclusively <br /> Agricultural/Horticultural ❑ yy Educational Religious ❑Charitable ❑Cemetery as indicated'? <br /> Give detailed description of use,including an explanation if multiple use classifications exist ''YES ❑NO <br /> The Chevrolet van is used -to -Fransport children a n-Duc a <br /> to +I1e. Churchi Child Care Center. If No,give percentage of exempt use: <br /> The Slue- Bird busses are used 4-o transport church <br /> members and cA1ldrer, 'to and -6-on'1 worship and <br /> eater. choral ctclivitres . <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 membership or employment based on race,color,or national origin. <br /> sign ,(��j��%/ � c/ru,Q 4y TR£+�sweer� <br /> //-16-- 20/6 <br /> here Authorized Signature Title Date <br /> 1 FOR COUNTY TREASURER RECOMMENDATION <br /> [']APPROVAL RECEI� ��,• / - � 9 d a <br /> ❑DISAPPROVAL <br /> DEC 3 0 2016 b " ' " v �'� - —.9°�7 <br /> Signature of Cou y Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND,NFy ,(YTS• <br /> ❑DISAPPROVAL a <br /> :Jio _!/Li r _ -rms.: — _ /-20—i7 <br /> • thorized Signature r Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77202)1)(0)and <br /> (d),and 60.3.185,and 80-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-2532006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />