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Xis <br /> Nom,*„ „--e__. Application for Exemption FORM of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •io bellied with your county treasurer. <br /> _._. . a .-.--.-_._____.__._._.—__._.___-__- <br /> ---_-____Read Instructions on reverse side...._—_._.__.__.___._-_—___-_._- <br /> ARWicent's Name .--_._- _--_--_-._-----.. <br /> ------ Type of Ownership <br /> GREAT PLAINS ANNUAL CONFERENCE OF THE UNITED METHODIST CHURCH Nonprofit <br /> Street or Other Mailing Address 511 N• Jm a- Ste 2 County Corporation <br /> HALL -1 <br /> City State _ Zlg Code --� State.Where Incorporated <br /> ---t 0 Other tsperaly): <br /> GRAND ISLAND NE -68882 (Ago I I NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide 1 Name:Address.Ciy,State,Zip Code <br /> - , f - :1 -- — .am.€ine can._'�?9�k 14°-_rn_� N� In - --- -- -- — -- <br /> .. .s _ r -- <br /> \)1Ce • - : .�. � ----Lt �, m rt Ic, �3�._.I�JC�- � �.Je_�na1:�--_ <br /> 4ca� '>Z� 11.1•f auto GoICht_. — KS la 73-1,4- <br /> v1 <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> _ Registration Date or <br /> Motor Vehicle Make I Model Year Body Type Vehicle ID Number 1 Date of Acquisition, <br /> — .�.._._. ___ _. .f-- _—_ 1 _ it Net Purchased_— <br /> I I <br /> I I <br /> I <br /> i <br /> I I <br /> Exempt Uses of MotorVehide: ___----_—._- Are the motor vehicles used exclusively— <br /> [l AgrictAlumL9lorticultural [,Educational ARetigicus ❑C.har:1Se 0 Cemetery as indi aced? <br /> Give detailed description d use,inducting an explanation E mediale use classifications exist: .'4%YES ❑NC <br /> SA L fat r UL 1 '71 ithAto 0A-2 vc- I <br /> II No,give percentage of exempt use: <br /> Under penalties of law,I declare that I have examined this application and that k 1s,to the best of my imowiedge and belief,true.complete,and correct.I <br /> also declare that I sm duly authorized to sign this exemption applicat ion,and that the oiganitffihn owning the above-listed property does not discrkninate <br /> in membership or employment based on race,color,or national origin.sign <br /> (71), r, <br /> here agi ra -a F 4te Dee <br /> -�— R CODUTYTRFJISURFR RECOMMENDATION --_ _-- -- ____I <br /> L— 424.4: _-77Ia <br /> oa,BAPPROVAL COMMENTS: aglain1y.-1 <br /> 0DISAPPROVA_ RECEIVED - - --- -- — -- - <br /> /4-a7,7' <br /> NOV 1 6 2017 ,Signature of County Treasurer Dale <br /> I______ - _ FOR COUNTa BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> ky]APPROVAL • TREASURERS OFFI)MMEN1 S: <br /> GRAND ISLAND,NEBRASKA <br /> o DISAPPROVAL <br /> eed Signature -- bate'-"--- <br /> •Nebraska Department el Revenue Authorized by Na Rev.Slat-$§:7-202'txcl end M.and 60-3.185.end 6(-3.189 <br /> N-253-2006 Rev.8-2011 Supersedes 85.253-2006 Rev 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />