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mat-n---e-- Application for Exemption FORM <br /> NelnastlkaDapagmon:of <br /> RE"Da "'E from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed wlh your county treasurer. <br /> EIIIMEIN •Read Instructions on reverse side. <br /> --...i. __.f. ._.____._.._.._ <br /> Applicants Name Type of Ownership <br /> NEBRASKA DISTRICT COUNCIL OF THE ASSEMBLIES OF GOD g Nonprofit <br /> Street or Other Mating Address COwiLy Corporation <br /> 1503 W 2ND ST PO BOX 1965 HALL 0 Other t <br /> 6emn: <br /> City State Zip Coda State Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> I IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANi7ATION <br /> The 'Name.Address.City,State,Zp Code <br /> _ALS tOENT _ — Bobo-k- w1•.a- _SOLI E 52.,a- s,:,,,-c+ T tiCte.f_(.icA.Or _v 8g_v_"L---- ______ <br /> _rra115in YllgE.$_SV QER__Zcrr 1 tp.w r l)'i Stem fix- t_q�- �vw.;o Irk N.. --.lu$'0`L._..._.____._.-_—, <br /> 71,2•€r'(rs2 ;Cztae..t NeNtA- s O'if Trr r'1A ter 1.1c.�1LA. ,-, NE LaI i33 <br /> I <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if nereseary. <br /> 1 F j Registration Date or <br /> Motor Vehicle Malta I Model Year L Body Type j Vehicle ID Number Date of Acquisition, <br /> a —___._.— ._._.__._4_.--._._._._._--_._._....__.._____.._it Newly Purchased <br /> S-4 ha e Sl,.t h-Q? <br /> i <br /> i <br /> ._-._.- <br /> Exempt Uses of Motor Vehicle: I Are are rooter vehicles used oxduciveiy <br /> [Agriculturaottkunural 0 Educations yl,Re;igious 0 Charitab e o Cemetery as indicated? <br /> lii <br /> I <br /> Give detailed descdption of use,mdarditg an explanation if maniple use dass4fcations exist YES i I NO <br /> 'Hess- JW,LieS o-rc. .. - a A-. c;1ae, Qos- ono. cc-et ko o1-.. - <br /> ' O - o -ro.,,as 0,na a-11. Of"n:SI-C :S 0.-(ro S5 -i-1,.e.. 51-n)t- Ii No,gvepercentago ofexemn!use: <br /> O S,- N 60 O-SV-a-• <C42-..\ 0.r2 t-tis¢_d k o co o c A.\n0.-e_ a,nA <br /> 't r,,.(�\C„m.e,;,3- 'p;vre.,c,r vi e..3+s, c_a.r--Fs , ctn.re-"M'ms , se-.1.7.1vAa <br /> • I <br /> 1 <br /> Under penalties of law,I dedare mat l have examined this application and that it re,to the best of my knowledge and belief,true.complete.and correct I <br /> also decals than am duty authorized to sign this exemption application,and that the organization owning the ahae-f sted property does not discriminate <br /> in membership or employment based on race,color,or national ongal. <br /> }sign � - /Z•-(a_' r7 <br /> Here Authorized Signature Titre Date <br /> L��^��-- _-_-.—�_--�-FOR COUNTY TREA�SjUyR/�ER�RECOMMENDATION —,^ .—_— —J <br /> IL�"WPROVAL RECEIVER MEN-S: £20 /60-1-4-- 5-5, "9-77-49c-z- <br /> 0 <br /> DEC 1 4 2017 �af /'-.4d =/7 <br /> P' Slga C my Treasurer rer <br /> Dale <br /> L_._._.___._—.__�_.—._ 111 OR COUNT BOARD OF EQUALIZATION USE ONLY._.._____._.__._._._.—__._._.__.__.____—_._._I <br /> hr-.__._.._._._._._.__— ._. .__.._.___- <br /> GRANDISLAND,NEBRASKA <br /> 63/(PPROVAL COMMENTS: <br /> 0 DISAPPROVAL <br /> ' Si{arature __ �C' �'.d Date __.__.__. <br /> tabraaxa Osparunem d Revenue Aiterized by Nal Rte.Slat.%TJ-20211xq and idf.and 508185.and 6153.189 <br /> 96-n3-2006 Pm 8-2011 S&oersedes 96453-2006 Rev 5-2039 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />