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�►�z Application for Exemption 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 /> •And instructions on mane aide, <br /> Applicant's Name Type of Ownership <br /> Great Plains Annual Conference of the United Methodist Church ]Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> PO Box 4187 Hall ❑Other(specay) <br /> City Stale bp Code State Where Incorporated <br /> Topeka KS 66604-4187 Kansas <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name.Address.City,State.Zip Code <br /> President Loyd Hamrick.10323 W Alamo St,Wichita,KS 87212-1221 <br /> Vice President Rev.Nell Gately,9359 Wapner St,Overland Park,KS 86212-1450 <br /> Secretary Jenele Erb,511 E 2nd St.Orchard.NE 68784-8448 <br /> Treasurer Scott Brewer,PO Box 4187,Topeka,KS 88804-4187 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,H necessary. <br /> Registration Date or <br /> Motorvehicie Make Model Year Body Type vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> Toyota RAV4 2018 SUV JTMBFREV2JJ216184 08113/2018 <br /> Exempt Uses of Motor Vehide Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational IN Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed descrption of use,'midday an explanation if multeRe use classifications exist El YES ONO <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 this application and that it is to the best of my knowledge and oebet 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 distemmata <br /> in memo p or employment based on race, r,or national origin. <br /> Sign Property Coordinator 08/292018 <br /> here ".Authorized Signature Tile Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ROVAL COMMENTS: *mitt & L- /tits "/ 7•a <br /> ad- <br /> ID DISAPPROVAL ( // �(,/a ��1e t/� ^(,�-A_�` !, 9�//J p <br /> Siren°of County Treasurer/ ` Bale "", <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> PPP''''''APPROVAL COMMENTS. <br /> it <br /> ❑DISAPPROVAL <br /> lar <br /> Au red Sigre -- e <br /> Nebraska Department of Revenue Aumaroxd by Nets Rev,Stat§071.2o2ttNct and tab.and 604.tes and relies <br /> 96253.2009 Rev.B¢011 SupwsMn 99.2534000 Rev.5.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />