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getii <br /> ten.---L--- Application for Exemption R M <br /> Nebraska Oeepartmam ni <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 457 <br /> Road Instructions on reverse aide. .—_.—.-_....__.___._._.._._.. _-.-_.. <br /> Applicant's Name Type of Ownership <br /> NORTHRIDGE ASSEMBLY OF GOD Nonprofit <br /> Sweet or Otter Ma!lino Address j County Corporation <br /> 3025 INDEPENDENCE AVE I HALL — ❑Other. <br /> City State Zip Code I State Where incorporated (specify): <br /> GRAND ISLAND NE 68803 I NE i .--...._.-..__.._.___ <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide I Name,Address.City Stave,Zip Code -. _ <br /> __5.. ClianWX_.__---- #4 11[E 5 A.Fr. -_.1.4 ds so_g_t TIw-_�_s_T, GA—D 1.514 , Iv£_ gro3 ------ <br /> PRES( Antic otsnaC . tI3 SA6'Eca06D Ave.)�GRAM "ISLAM, 116 (oQ'Ca3 <br /> 1 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,If necessary. <br /> i I Registration Data or <br /> Motor Vehicle Make Model Veer j Body Type I Vehicle ID Number I Date of Acquistfon, <br /> __ i if Newly Purchased <br /> ___Fpm----- —. Moog ._{ �car�o�tn wh6oa�__!rass3 �ZBD�z'S <br /> - 'Fo04.) I ItS 4Ensso CIS cAa? 1n3TsalMos/4 af9 % <br /> Cl.as'sfc 1 Ills I Eroct-ose-D 17414fR.+ tok,AA663tis-wines" <br /> I <br /> i <br /> I L <br /> Exempt Uses of Motor Vehicle: .—_—_—I Are the motor vehicles al exstt ively <br /> 0 AgriouturatHlorticultural 0 Education g••Red gious 0 Chadtab!e <br /> 0 Cemetery ins indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist — •l ^- - i 14 YES ❑NO <br /> WE btS& -RIESE VEM(cLys i✓ iL ilAnsfen:T,c1NJ BP Ie°PU' jItNa give percentage of exempt use: <br /> ANt) kkGa6•A 6E –to A en) F4DS C Ruital (2Zi41tb EVZiJT % <br /> Under penalties of law.I declare that I have examined this application and that it lz to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> Si membership or employment based on race,color,or national origin. <br /> Sign at• .Q.�� ( dSic /1-`/-(7 <br /> ! here - 'loo and Signature • <br /> Tree Date <br /> !_—_—_. ._,.___.— FOR COUNTY TREASURER RECOMMENDATION �y ._.___I <br /> APPROVAL RECEIVE' E °: ' '' s �J ,s s, '7/ —egoa2 <br /> ©DISAPPROVAL <br /> NOV 1 5 2017 — — — <br /> b' Q-�� -- —i4-ate, 7 <br /> Signature o C ty Treasurer Date <br /> L FOR COUNTY BOARD OF E UAUZATION USE ONLY <br /> TREASURERS OFFICE <br /> V APPROVAL - GRAND ISLAND,NEBRASdiash . <br /> ■ <br /> ❑DISAPPROVAL .. <br /> / F 91-7:7 <br /> rize.-watt' - Date-- <br /> ,•je <br /> Sr ebsa+a Oepa.eneat or Revenue Authorlmd by Neb.nem star$$n-2o2(1)(0)end(mi.end 604,185.and bas,tae <br /> RS-253-200e Ram 8-2011 Supersedes ee.253.2 Rev 54003 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />