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- Application for Exemption FORM <br /> Nebra --ska Departmnrn or <br /> REWNUE from Motor VehicleTaxes by Qualifying Nonprofit Organizations 457• <br /> To be filed with your county treasurer. <br /> '" •Read instructions on reverse side. <br /> -__---_ <br /> Appfrant'a Name T ype of Ownership <br /> __. <br /> cr <br /> GRAND ISLAND EVANGELICAL FREE CHURCH ()(Nonprofit <br /> Sheet or Other Mairmg Address County Corpoa:ion <br /> 2609 S BLAINE ST HALL <br /> ~ U Other iayy: <br /> City -------- Sate ---- Zip Code - Slate Where Incorporated <br /> GRAND ISLAND NE 68803 NE _—.-_...._—__. <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> The I Name,Address.City,State,2p Code <br /> C'.._ Styc r,. xi.--------....._----i K_r\c. Q.Y-N an,..aJn� 1_Al �L_.F..2,1 ` a�a'� -.5.43% t..__ ___ <br /> -4S.Y_e 9.-..t - r�S@.L �.Yac s- aas \x1oc&c .L+� £--b"3`dfl.1--'- <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,it necessary. <br /> i i I Registration Date or <br /> Motor Vehida Make 1 Model Year ( Body Type I Wilkie ID Number I Date of Acquisition, <br /> _.-._._yi_._it Newly Purchased <br /> F -' -- — -I- -- c,,L\ _—«t 3sU_. SLT \ Q•,-,.._I_ 1 v SS . 1..sats-1 o I cis---_�°‘1----- <br /> St'. I . IaN t ... .. O �• \.- . -A Yv. . aCa <br /> w .! N. o rC�t'Z� 3ReR1 Zi1{�T.�fai�llR.�G�. ._. <br /> i • <br /> EzemprtA`as of Mclo:Vehicle: -_ ---___ ----i Are the motor venicbs used axdusive+y� <br /> 1 AgriculturatHo,ticoltural 0 Educational RReiigious 0 C.harilat%e [j Cemetery i as indicated? <br /> Give detailed description of use,inducting an explanation it multiple use classifications exist IYES LINO <br /> �Qh\c\@A Quo-Q_ V.i�@ �` n Na give percentage of exemo use: <br /> �`cw.�v� `c eAo. I <br /> war 4-'-\\r-w\ <br /> Under penalties of laaw,I declare that I have examined this application and that it is.to the best of my knowledge and belief,Vila,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization awning the above acted property does not discriminate <br /> in membership or emoicyment based on race,color,or rational origin. <br /> 3(sa-\CZ.cti <br /> Sign <br /> �Vsat. �4t,�t ,w.ea..�� �cc�ls.x��.c. \\ \. --.LA <br /> f here l Authorized Signature Tried Date <br /> !.-_---__---.---_ ---_FOR COUNTY TREASUREFI RECCO}MMENDATION _-----------_-.-g <br /> r APPROVAL MtwtN Sc 6S*. "f�- /�^� it •S,S, x`77--t 0.'� <br /> DISAPPROVAL <br /> RECEIVEb S — — ---�J _ �j _.--�.y <br /> NVV 1 7 2017 ® nty�C '- 49-47-,' <br /> Date <br /> FOR COUNT BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> -APPROVAL - <br /> TREASURERS OFFICE <br /> GRAND ISLAND--NEB <br /> Nt <br /> Ej DISAPPROVAL <br /> i <br /> sigrtet:ae Data <br /> Nebraska Deparaneof M Revenue Ata,orized by Neb.Ray.Slat 0770:20)N and(dl,and Cronin and sas.ta9 <br /> 913-70,2986 Pew.8-2011&neraedoe 98-253.2005 Rev.•r2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />