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Rebooks D•par•mem or .rr•• " •"'• ••r"•"'•• 1-Ulm <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 Type of Ownership <br /> ST. STEPHEN'S EPISCOPAL CHURCH <br /> till Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> P. O. BOX 2317- (422 WEST 2ND STREET) HALL <br /> ®Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68802 NEBRASKA <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Rector Rev.Dr. Robert M.Lewis;2642 Carleton Ave.#8 Grand Island,NE 68803 <br /> Rector's Warden Jerre Mallory;802 Sun Valley Dr.Grand Island,NE 68801 <br /> People's Warden i Don Young;402 Renee Rd.Doniphan,NE 68832 <br /> Office Manager Lynne Nuss;1621 Kendall St.St.Paul,NE 68873 <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 /> tl Newly Purchased <br /> Ford Taurus 2007 4-door sedan 1 FAFP53UX7A148569 8/15/2008 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural ❑Educational ®Religious ❑Charitable ❑Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ONO <br /> Transportation for the Rector, Parish Staff, and or its members in order to share the gospel, <br /> provide outreach and ministry to all persons, including shut-ins, and the needy of Grand If No,give percentage of exempt use <br /> Island and beyond.Also used for travel to and from services, residences and church <br /> meetings, conferences, retreats and Youth events such as summer camp. <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 /> A <br /> sign ' J ! `,'�7 L - -), Finance Secretary 11/16/2016 <br /> here„... Authorized Signature . Title Date <br /> `-- 1,�eFOOR COUNTY TREASURER RECOMMENDATION 4" �l <br /> [L PPROVAL RLCE'VEDMMENTS: �/121-4-1 4/ 7 ���.a <br /> ❑DISAPPROVAL iii/// <br /> NOV• 1 7 2 15 /_.St/ "i <br /> k Snature of Co Co ty Treasurer <br /> Date <br /> HALL COUNPS OUNTY BOARD OF EQUALIZATION USE ONLY <br /> Tr:` RE-SOFF <br /> _ GRtND:SLANE),NEBRASKA <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL / 7 <br /> •uthorized Signal frr Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)Ici and td).and 60-3.185.and 60-3.189 <br /> 96253-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />