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NP,o 4 A l Application for Exemption FORM <br /> Good Life.Great Service from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •e <br /> -To be riled with your county treasurer. I 457 <br /> w'•'• •Read instructions on reverse side. <br /> Name of Organization <br /> Type of Ownership <br /> DONIPHAN UNITED METHODIST CHURCH ©Nonprofit Corporation ❑Other(speedy): <br /> Name of Owner of Properly County Name State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 303N 6TH ST PO BOX 188 MAO HAS ICI n1S 4102 Sys 2761 <br /> City State Zip Code Email Address <br /> DONIPHAN NE 68832 don ipbonumc® 11aini icon. net <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,State,Zip Code <br /> -• S1 • h •URI Ci.fEGis— 030 W •OSEDA1LE RD De, I• i 6:1'32 <br /> SECRETA-RY PEE NEDrl?AXi 349 SLa.1CFT DR. DDAI IPNAN Mc1cs32 <br /> - TREASURER al4Rfc I.1-ASKINS 2140 W BIt4FrELD PIZDONipHA-tjeA)E•::32 <br /> . CHAIR TRR . EES (14 eNLRUTEAI tULrl&ER 576 W r FIELD DR DOA111) 44 ME •::•32 <br /> • Description of the Motor Vehicles <br /> *Attach an additional sheet,if neessary. <br /> Registration Date or <br /> Motor Vehicle Make - Model Year BodyType Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> CHEVROLET toot 630 VA-N 1GA4 39R91120576o O2/22/20Ig <br /> CffEVROLE7 IR44 ?s0 BUS i68KP32RX3 0tf748 of / O/Jo4S' <br /> CHEVROLET i999 P30 .uS 16,B Kp3Z RXX330g77q 01 /D/20 ig <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation It multiple use classifications exist: RYES ❑NO <br /> THE GSA EXPRESS VIN IS USED Sy DIE Cl-llLPG4RE CEAJTER <br /> TO TRAJJS PORT C$/!C_AREAI BETWEEN THE PUBLIC SCHOOL /{ND Ttl-7 it No.give percentage or exempt use: <br /> PAYCAR&- CENTe-R. IT' a244' i9LSo SE USED '1b TRANSPORT % <br /> MEMBERS lb ,4M0 PROM RcEL$GIbUS SERVICES OR .4c77Or/ES_ <br /> THE 32 A4+ SEN&ER BUSSES APE USED To TRA-MsPORT,fEAr eE-2s <br /> TO AA)D FRom RELIGIVUS SERVICES OR ALT, VITlES_ <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete <br /> I also that I a duly auth ' gn th', exemption application. GH-14.2G4F <br /> a sign -,Rtes&Re2 12/0972o)s <br /> here I Authorized Signature Title Date <br /> IFor County Treasurer Recommendation 1 <br /> Approval RECEL VEQommens: hen per OSS -it 77- <br /> ❑Disapproval DEC 1 2 2018 br gin wM/a. <br /> - WW1-rc M� / fi t <br /> of uny Treasurer Date I COI INTV <br /> TREASURERS OFF10Efpr Cot my Board of Equalization Use Only <br /> GRAND ISLAND,NEBRASKA <br /> JXj Approval Comments: <br /> ❑Disapproval <br /> 4 ///LLi ,- 62-J.cf <br /> • .hertz:•' '•nature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rex.Stat.§§77-202(1)(c)and(d).and 60-3.188 and 66-3.t89 <br /> 96 253-2008 Rev.7-2018 Supersedes 96-2532006 Rev.8-2011 <br /> Please retain a copy for your records. <br />