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&017 <br /> +t^--t-- Application for Exemption FORM <br /> Nebraska Deportment al <br /> REVENUE I from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be M ed with your county treasurer. <br /> •Read Instructions on reveres side. <br /> Applicant Name Type of Ownership <br /> THIRD CITY CHRISTIAN CHURCH ri Nonprofit <br /> Street or Other Melling Address County Corporation <br /> 4100 W 13TH ST HALL ❑Other(speci <br /> Cory Slate Zip Code Slate Whore Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tllle Name,Address,City.Stale,Zip Code <br /> p (chairman +� C.1E�r,a�,k,,as.2Etelydr v4lPrCa�kd sl��yy�� t� lo8So <br /> reasiArcr A jt. 1Jef 81L{� -1 4t� ��r■lyr(Yd. nbIC�Rivcr aaggs_3 <br /> Ai �Ku4+lriani 2./Ac N,}:ic* 1 brafka, tan l r! °� (46c3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> Registration Dote or <br /> Motor Vehicle Make Model Year 9odyType Vehicle ID Number Date of ACqulaalon, , <br /> If Newt/Purchased <br /> FORD 1990 BUS 1FBSS31543HA47093 <br /> FORD 2003 ECONOLINE VAN(BUS) IFDNJOSPSLVA12040 <br /> INTERNATIONAL 1997 BUS IHVBJABPlVA078028 <br /> BLUEBIRD 1998 BUS IBAA005H2WF077702 <br /> _thpa ;1 Wi BtAS 2003 0(45 4444)0tktrG G $5a3 _ <br /> Exempt Uses of Motor Vehicle: Are me motor vehicles was............._., <br /> ❑Agrkuhura$laticottural ❑Educational DU Religious ❑Charitable ❑Cemetery Indicated?as <br /> Give detailed description of use,Including an explanation If multiple use class elan selxbtn:n(�/�/� /� 94 YES 0 N <br /> �Lp�C- Yt,l`'s.^"�j WYe I+F1fft�v1l t"„s 'YI"17 (y yl�)�i'� gNG,give percentage of exempt use: <br /> � �"k b2 d or °A CV- ni-W5 4C5 % <br /> •� (ri541. <br /> n Ck A.r(d, <br /> Under penalties of law,I declare that I have examined this application and that II is,lo the best of my kwvAadge and belief,true,complete,and careoL I <br /> also declare that lam duly authorized to sign this exemption application,and that the orgam:ationowning the above-listed properly does not discriminate <br /> In membership or e 1 nt based on race,cola,or national origin. <br /> sign ,h Ems,_ <br /> E /�` y—/� <br /> here►Authorized Slgnniur Tce Date <br /> FOR COUNTY TREASURE//R RECOMMENDATION <br /> APPROVAL RECEIVEDENTS: .6 A" AL € 77 9© <br /> 2- <br /> ❑DISAPPROVAL �� J <br /> DEC 6 2016 ►ypnatasofDa aG _/+2� 1 /e 57-'7 <br /> I FOR COUNTY BOARD OF EQUALIZATION USE ONLY i <br /> MALL COMITY <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND Nfa y <br /> ❑DISAPPROVAL <br /> 'a fib ilitc 1.�'...t{/ do �j horned Signal ,i <br /> Date <br /> Nebraska Department al Ran* Authorized by Nee Iles Sim y§77-202(1)(4 and(d).end 604185.and 804199 <br /> 96.295.2005 Rev.62911 Supersedes 90-255.2005 Rev.54009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />