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• <br /> qffi^------7— Application for Exemption <br /> FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> i •Read instructions on reverse side. <br /> Applicant's Name j Type of Ownership <br /> Trinity United Methodist Church g]Nonprofit <br /> Street or Other Mailing Address I County Corporation <br /> 511 N Elm St <br /> Hall ❑Other(specify): <br /> City State Zip Code I State Where Incorporated <br /> Grand Island NE 68801 l NE <br /> i IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> 1 <br /> Title 'Name.Address,City,State,Zip Code <br /> • <br /> • <br /> Trustee Chair f Gloria Gress,2220 20th Ave,Central City,NE 68826 <br /> Trustee Herb Roeser,2316 Pioneer Blvd.,Grand Island,NE 68801 <br /> Trustee 1 Karen Reese,2123 W Koenig,Grand Island,NE 68803 <br /> ITrustee i Joe Watkins,320 Ponderosa Dr.,Grand Island,NE 68803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> l •Attach an additional sheet,if necessary. <br /> I Registration Date or <br /> Motor Vehicle Make I Model Year I Body Type Vehicle ID Number Date of Acquisition, <br /> H Newly Purchased <br /> H&H Trailer Trailer TTFTCA7X16 5JWTC1624JN02995 1/19/2018 <br /> I i <br /> I <br /> , <br /> I <br /> Exempt Uses of Motor Vehicle', Are the motor vehicles used exclusively <br />• <br /> Agricultural/Horticultural ❑Educational �I Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: RYES ❑NO <br /> Trailer used to haul supplies to Loaves& Fishes Food Bank, monthly free giveaway of food <br /> for 350 to 450 families in Grand Island. If No,give percentage of exempt use: <br /> 5 <br /> Under penalties of law,I declare that I have examined this application and that it is.to the best of my knowledge and belief,true,complete,and correct.] <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 /> in membership or employment based on race,color,or national origin. <br /> sign siturivi. NipiAmpe �,,- a- e3-11 <br /> here I Authorized Signature Date <br /> • <br /> FOR COUNTY TREASURER ECOMMENDATION <br /> OAPPROVAL RECEIVED MENTS: ^' """ �'P�� 4/5.5- '177-Qc <br /> ❑DISAPPROVAL <br /> FEB 2 7 2018 jl a ? air-i� <br /> It Signature o <br /> County Treasurer Date <br /> HALL COMMCOUNTY&CARD OF EQUALIZATION USE ONLY <br /> *RE,toll RCCG O'r•ce <br /> ,,,���((( - GRAND ISLAND,NEBRASKA _ <br /> X{I[J APPROVAL COMMENTS: C. <br /> DISAPPROVAL 'I / <br /> _At luA�l j - a.�ti— -.. 3. ' /8 <br /> Worized Sign. re Date <br /> Nebraska Department M Revenue Authorized by Neb.Rev.Stat.§§77-202(1:(c)and(dl,and 60-3,185.and 60-3.189 <br /> 96-253-2005 Rev.8-2011 Supersedes 96-253-2006 Rev,5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />