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A-0 17 <br /> e^� Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor VehicleTaxes 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 /> FIRST PRESBYTERIAN CHURCH ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2103 W ANNA ST 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 />• Tide Name,Address,City,State,Zip Code <br /> / • i / . / / <br /> L.J1r1� en.4._A t_..0i�.' goo Pi_it�.y�..�, !r - 1861 <br />• <br /> ,IF_. .a -_��__ r.,... 7 • 8 . .9 1• .- _ S . 1863 <br /> J ,in i o - / ■/ t l� J <br /> Eno <br /> 1 / 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 ID Number Date of Acquisition, <br /> if Newly Purchased <br /> CHEVY 1999 SPT VAN(BUS)- 1GAHG39J5X1065404 <br /> CARGO MATE 2000 16'ENCLOSED TRLR 4X4TSE616YN021934 <br /> GMC 2000 SAFARI VAN - 1GKDM19XUB543671 sdete sO,/ /Ito <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgricultumUHorticuhural ❑Educational ciii Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> �c.�...-04 i/'tvsvv(f-vco bri � If No,give percentage of exempt use: <br /> // <br /> )1/1.vJ�r-e-r- I/�cr y A2t t st..-,.-GC .e.g...-e-rsio In `iac.....C. <br /> a aj A <br /> Under penalties of law,I declare Nat I ha a fined this application and that it is to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that lam 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 ,��.101 srjGu -?S'- /� <br /> here A horized Signature The bate <br /> FOR COUNTY TREASURER RECOMMENDATION/2 J ma /W cy- <br /> t 77s —Z <br /> P1CKPROVAL F .V EIVEDIENTS: `i <br /> ❑DISAPPROVAL <br /> NOV 2 8 2U116 d-/2-2 r - -/- y <br /> /;ignatur asurer <br /> Date <br /> HALL comet• BO\RD OF EQUALIZATION USE ONLY <br /> GRAND ISLAND NEBRASKA <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> . J <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77402(1 Mc)and(d),and 603,185,and 603,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />