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60 / 7 <br /> makiLZ Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> GRAND ISLAND EVANGELICAL FREE CHURCH ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2609 S BLAINE ST HALL ❑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 r�Name,Address.City,State,Zip Code <br /> e,hQ i<trm:� `str Na\\/cc c c J t—1 1V S C'\0 o @\can.C1/4 ``k rc2c� \an' \E Le�lei3 <br /> G 9 <br /> �e_ or v... \Caryl-- T'c dl„R•� 'a<11C. \ 6,—(K\t-( \ n "4lrcstt.A ' ,,r laF_ Lai- c-1i <br /> 1 <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 I Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> FORD ' 2011 E350 XLT VAN(BUS) 1FBSS3BL5BDB17181 'ZC+x._ 'a n i(< <br /> FORD 2004 ECONO VAN(BUS); 1FBSS31LZ4HA73735 _JV`tn ' .o\c <br /> GMC 1998 SAVANA G3500(BUSJ 1GJHG39R3W1044300 Scyh, ao\4 <br /> FOREST RIVER 2003 UTILITY TRAILER. 4X4UTS0153W014534 jca x. "all l`.. <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturabMonicultural ❑Educational ®Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist:` 1 _` ®YES ❑NO <br /> ��� \�N 1C\QT� c-� c1 a,s ""ea c If No,give percentage of exempt use: <br /> r. <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. \.c03 953 <br /> sign . as:\ t,\- \\-aA -\ „ <br /> � _ .Wk: 9.471 rmcrn.n <br /> here Authorized Signature Title Date <br /> I FOR COUNTYTREASSU URRERRRREC�OM'MENDATION 1 <br /> APPROVAL yg�fj lPr�,COMMENTS: 'CZ'1- °%r .S.4s �' 'i'7'-v��y'S <br /> 9 DISAPPROVAL RECEIVED <br /> /Q-c17 s-- /co <br /> NOV 2 8 2010 Signatu ty Treasurer Date <br /> 1 FOR COUP_TY BOARD OF EQUALIZATION USE ONLY <br /> I HALL COUNTY <br /> ❑APPROVAL -7'.7 I IRERS OFFICEGOMME VTS: <br /> V <br /> R0...;, "ND,NEBRASKA <br /> ❑DISAPPROVAL t <br /> w �i . pliry :,../..—.._ .L% �/ /—/7 ! y <br /> -T <br /> •nzed Signature Or. Dale <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-2e2(1)(c)and(d),and 60-3185,and 60-3,189 <br /> 96-2532006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />