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7 . <br /> ae^_--z— Application for Exemption FORM <br /> Nebraska Department or <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be tiled wah your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> NEBRAKSA DISTRICT COUNCIL OF THE ASSEMLIES OF GOD ($Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1503 W 2ND ST PO BOX 1965 HALL ❑Other(specy): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 14 E <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title ` - Name,Address,City,State,Zip Code c,� <br /> PRt.S.dG,nt (tabCA.* t.AFrIC 5D6 a 52.4 S Lai-Vt KG4ttAey ME (0889`( <br /> 5ccacAt-A4 hRe••9..aaa Tes.a.i, ORowA Iv450 Foi9Iove Late, L;„co(in NE toS504 <br /> D■}t\e.G}oR GaRy Moyf' 5104 7tsibc4R45e PRive, Ftxf;thor, NE tag 133 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year BotlyType Vehicle ID Number I Date Newly Purchased <br /> isaion, <br /> It Newly Purchased <br /> SEE ATTACHED Shie-t% <br /> -coo 1, Veat.atc – <br /> Exempt Uses or Motor Vehicle: y.� Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational IYI Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation a multiple use classifications exist: IKI YES ❑NO <br /> ikeSe. veA,.;atis 04-cc! vSea -to 3Cve Pass-arc-1 CCJ a 40 oat �v.oxe T� <br /> '(4^G-K R0 Gltiu RCL.>rs awti Cc Kovka a-ZS kV ":"1 5I -4 &CAQSS *ke lfNo.givepercentageofezempluse: <br /> % <br /> jc�c o� NGAoP.wSKG ( cy cute- v5r� fb eool,dkZc e "-AA <br /> iMilb1.,/,,.en4 Ti -ttt:c-t eve wtc, (A. p coAuaJrYon SA �tr.Aa...GRS <br /> cvc-, �,k1c.ck nawLe' i olgt&-Fes, <br /> s.;5 c a 3'64-1134 <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 <br /> here ,Authored Signet u if Ti vim: to —t -' <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> 1/r�'APPROVA. WMMENTS: 4 �� ,4K.45-:- ..� ' 27`ac 2 <br /> ❑DISAPPROVAL RECEIVED z <br /> NOV 2 8 2C13 Signature of ou y Treasurer Dale <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> ❑APPROVAL, GRAND ISLAND,NEBRASIlanut , N 5. <br /> ❑DISAPPROVAL <br /> a <br /> J 7' <br /> • thorizetl ig Ile- Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Shat.§§77-202(1)(c)and(d),and 60-3,185.and 60-3,159 <br /> 95253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />