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gorLZ Application for Exemption FORM <br /> Nebraska DapwrrNnl U <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county Musa.•Read Instructions on reverse side. <br /> Applicants Name Type of Ownership <br /> Great Plains Annual Conference of the United Methodist Church y_, No yrotit <br /> Street or Other Malang Address County Corporation <br /> PO Box 4187 Hall 0 other(specify) <br /> City Slate Zip Code State Where Incorporated <br /> Topeka KS 88804-4187 Kansas <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name.Address.City,Slate.Zes Code <br /> President Loyd Hamrick.10323 W Alamo St.Wichita,KS 67212-1221 <br /> Vice President Rev, Nell Gately,9359 Widmer St,Overland Park,KS 68212-1450 <br /> Secretary Janette Erb,511 E 2nd St,Orchard,NE 68764-8448 <br /> Treasurer Scott Brewer,PO Box 4187.Topeka,KS 866044187 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. <br /> 1 - Registration Date or <br /> Mohr Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> Toyota RAV4 2018 SW 2T3BFREV3JW721376 08/13/2018 <br /> Exempt Uses oI Motor Vehicle' Are me motor vehcles used exciusiely <br /> ❑AgrlculluraWHorticuttural ❑Educational ®Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use.inducing an explanation if multiple use classifications most ®YES ❑NO <br /> These vehicles are used by employees of the Annual Conference in necessary church duties <br /> If No.give percentage of exempt use <br /> of providing services to the churches of Nebraska and Kansas. Meetings are held <br /> throughout both states and transportation is also needed to travel to connectional • <br /> conferences in other states. <br /> Under penalties of law.I declare that I have examined des application and that it Is to the best of my knowledge and belief.true,complete,and correct.I <br /> i 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 member or employment based on race, national origin. <br /> sign Property Coordinator 08/29/2018 <br /> here ,Authorized Signature Tele Date <br /> R COUNTY TREASURER RECOMMENDATION �J�j J'.�.�y <br /> APPROVAL COMMENTS: ° t ! ASS / I- 229— <br /> pISAPPROVAL <br /> 11 Blptwture of County T surer 9 <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: // \'y <br /> ❑DISAPPROVAL ell / / G//(j�// / pry <br /> Au. Signature i . /4.L -t - i I'-e YV <br /> /, /// <br /> Nebraska Depa•sneri ol Revenue weaned by huh hex Slat if 77-202(11(c)and lei.and 60.3.115.and 601169 <br /> 96-253.2106 Res a MI l Swanseas 96-252-701w Nev.b-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />