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--z Application for Exemption <br /> h' ska Department at <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> amp •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> DONIPHAN UNITED METHODIST CHURCH <br /> i Nonprofit <br /> Street or Other Mailing Address County rporation <br /> 303 N 6TH ST PO BOX 188 HALL ❑Other{specify): <br /> City State Zip Coda State Where Incorporated <br /> DONIPHAN NE 68832. NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name.Address,City,State,Zip Code <br /> Chair o Ad Ilan . Lau/It 1 u e. t 4030 LO Pose e t a Rol , (at 132 <br /> Chair -^01 trycs-tteS A �-r— <br /> Trrncu for M�An,rrk �kirns 3L40 u curia KA Oonrpha.t r ,LYE 1.843--L- <br /> _ tt7 R!/S_DA 10-1 _l_Ng 1344&2 <br /> DESCRIPTION OFTHE 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 /> It Newly Purchased <br /> Che-01 0001 6x rvxc_41nA- iCA}463A0-4.tIao.S�LL_ 3'a- is -- <br /> AltAr u-8,-n4 iR3f 6143 ietKP32. 330E074 -10 - t` 1 . <br /> 6 Its a g:ea 144t Q 44-5 16 b K P 3115X 3301741 Ln-1- <br /> Exempt Uses of Pria:r Vehicle: Are the motor vehicles used exeklsively <br /> `i AgdculturaUHO.tiouttural ❑Educational [paReaglous ❑Charitable ❑Cemetery as indicated? <br /> Give detaik3d description of use.Including an rear explanation if multiple use classifications exist ,�YES ❑NO <br /> To -transport- Clot.;Ikea- 4Q A f-tt +'n Qa-;✓,-1--ieS If No,give percentage of exempt use: <br /> To +ras s p or+I 90 Lott q toLtp +o and �o A GI-t t te5 <br /> rot. tt& L5 44-A -JOn +p elm-tit-Cc Athol 0; 44 es <br /> Cov,+&-e+ ,baste 12SS & ti. n7 boa S 1 <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 data 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 .J{ �� A� � r {� <br /> hereFAut`. ad .w -�IC�e7�-°--- "'C'—'"` .-------- FMt3�-" - -------._._.. Date <br /> [� FOR COUNTY TREASURER RECOMMENDATION <br /> ! APPROVAL <br /> #RECEIVED �: � y�CO } TIy-`1S -7'7~aOa. <br /> []DISAPPROVAL <br /> DEC 1 t 2017 <br /> HAI I Poetry 10 Signature of -nty Treasurer Date <br /> TREASURERS 0FSOUNT' BOARD OF EQUALIZATION USE ONLY <br /> CRAND ISLAND,NEBRASKA <br /> ]-APPROVAL COMMENTS: <br /> ❑DISAPPROVAL ' <br /> San e <br /> -d Signature Date <br /> Nebraska Depeitmont of Revenue Authorized by Neb.Rev.Stet§§Tr-202(1)(c)and('t.and 50-3.195.and 509.189 <br /> 95253-2008 Rev 8-201 t Supersedes 96-253-2005 flea 5.2000 <br /> PLEASE RETAIN A COPY FORYOUR RECORDS. <br />