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020 /7 <br /> Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •T0 be filed with your county treasurer. <br /> limacecommEa •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> GREAT PLAINS ANNUAL CONFERENCE OF THE UNITED METHODIST CHURCH ® Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2418 WEBB RD STE I PO BOX 5048 HALL <br /> ❑Other(specify): <br /> CiN State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tale Name,Address,City,State,Zip Code <br /> la it •rcain "Time Ernr t4on Po tiaL 40 ( e y to VQ4 <br /> 1?iLe - • s A7.__) • •I-0 UCLA)' C-k■ W- .41 ,. Sl• WtchL 'Cc (0-2c;113- <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> -Attach an additional sheet,H necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Nau/y,Iy P rchased <br /> HONDA 2016 ACCORD 1HGCR2F30GA094290 t-GLLO�j(p <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> El AgriculturaUHortiabural El Educational IBC Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist. 1411ES ❑NO <br /> - <br /> - <br /> 31 f ) -DYv 1573 11,2.4ttd If No,give percentage of exempt use: <br /> Wit � a � k ) P fig) <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 duty 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 , s as-Arer&feR�NTE• t - �z- s• f6 <br /> here Au 4Yr'" -'gnaw s Title Date <br /> c FOR COUNTY TREASURER RECOMMENDATION <br /> .63, eint COMM A a l--,S: <br /> 77- <br /> PPROVAL RECEIVE a2o4' <br /> ❑DISAPPROVAL <br /> DEC 7 2016 ���� �� ���• � /a- <br /> 'Si nature of County Treasurer Date <br /> FOR COUNT) BOARD OF EQUAUZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND,NEBRAB)R,MFtaS: <br /> ❑DISAPPROVAL <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.StaL§§77-20201(c)and(d),and 60-3,185,and 60-3.189 <br /> 96-253-2006 Rey 8-2011 Supersedes 96253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />