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Nebraska Department or <br /> Application for Exemption FORM g <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> latimEmna •Read Instructions on reverse side. <br /> Applicants Name !type at Ownership <br /> FIRST PRESBYTERIAN CHURCH I ❑Nonprofit <br /> Street or Other Mailing Address County ' Corporation <br /> 2103 W ANNA ST HALL <br /> City State ID Code State Where Incorporated Utter(speG(y): <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> u= Name,Address,City,State,Zip Code / h <br /> Ii_ --__- -- rti. .r_ _] • ♦ • r71T _y.•�i y II .4111 ,S-1.91W.4 4a ) <br /> - 3 <br /> Kul ! � -iird. :ono - -o - _ 111'!!• �1_�!.11E ha <br /> f <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Data of Acquisition, <br /> if Newly Purchased <br /> /939—_ .S —tSAH4I io tai V jd aoo0 it <br /> styq?SE6tb rNo-2)93Sg <br /> Exempt Uses of Motor Vehicle: f�.� _-- Are the motor vehicles used exclusively <br /> 0 AgdaitureUHortlaau:al ❑Educational t]y Rellgmus ❑Charitable ❑Cemetery as indicated? <br /> 6� <br /> Give detailed description of use-including an explanation If�,multiipllee u,,se�clessirxratans exist �- J *may°_ ' YES ❑NO <br /> Yitur�rL t-eivr " 't a'� �' 4 If No,give percentage of exempt use: <br /> P4.47-.4 2,(Ar - Atatate 4- ....4.44_,--$...r.. pt.e....64.4-0..4 <br /> -..nx.e yvo-€4. .. ant 4-e f0 <br /> Under penalties of law,I declare that I have examined this applcation and that it is,to the best of my knowledge and ballet,true,complete,and correct.i <br /> also declare that 1 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 � -� k ---L!Qn - &A>� /01- G -17 <br /> ------- ---- -------------- - <br /> ere . Bed Signature Title Date <br /> ���y�p�p FOR COUNTY TREASURER RECOMMENDATION <br /> `°' AL RECEIVEDOMME US: '1"""-/ /— /488' #77-"Q4Q112-1 <br /> DISAPPROVA4 <br /> DEC 1 1 2017 ,W&-ezi,/r, /a_Q7_/7 <br /> r Signature of County Treasurer Date <br /> • ,REDADS o COUNTY BOARD OF EOUAUZATION USE ONLY <br /> 6 R R <br /> GRAND ISLAND,NEBRASKA <br /> i(i]APPROVAL COMMENTS: <br /> ❑DISAPPROVAL , / <br /> rized S gnat _ .. ___ _ <br /> Nebiasia Departmend d Revenue Authorized by Neb.Rev.Stat.§§77-202(l)(c)and(d).and 603.185.and 60-8,189 <br /> 96-25a-2006 Rev.&2011 Supersedes 46253-2006 Rev.52004 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />