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<br /> N A.. Application for Exemption FORM
<br /> --e3 Se ;ca I from Motor Vehicle Taxes by Qualifying Nonprofit Organizations
<br /> I •To be filed with your county treasurer. 457
<br /> o.»,rmee a...v.ea I •Read instructions on reverse side.
<br /> Name of Organization Type of Ownership
<br /> GRAND ISLAND EVANGELICAL FREE CHURCH ®Nonprofit Corporation pother(specify):
<br /> Name of Owner of Property County Name State Where Incorporated
<br /> HALL NE
<br /> —
<br /> Street or Other Mailing Address Contact Name Phone Number
<br /> 2609 S BLAINE ST .\\(ec . AC c tvcq v_ �a—V Ns) CAL'd
<br /> City State Zip Code E AAddress
<br /> GRAND ISLAND NE 68803 .\\c Y\e \ \@ C2\ -,1*C • c r
<br /> Identify Officers,Directors,or Partners of the Nonprofit Organization --i
<br /> Title Name.Address,City,State,Zip Code
<br /> �.'hcc-.`c me c. c'.s .S<`�,n '��-1 w 'N.�.; • 3'v Esc 1 i1e s� \vZ Ca`r,`xn t
<br /> -seore�12,t v. corA- KiLCsr,w;' .AAG W c14Y RsAva R'.ti ".,, kA 1v� t3„ c'I 1
<br /> Description of the Motor Vehicles
<br /> •Ah ch an additional sheet,if necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition,
<br /> if Newly Purchased
<br /> 4\--(3-tA -a..QA\ 3�� \cC \1cen - l. \--1%.',-,--,I cl,,\. S CSI\---%\Mk ,jct,\ -a-C)OS
<br /> \--oz-c\. aQicaLt E.Q C b' \ F6SS L2 Li N A 1o_c-, av t`a
<br /> INC ( � t 4 cc% S` '�vclau_cn3 (3.w) \ J \t 4 4 ui\C —Zi^ , a-,;l4
<br /> \.N K\VHr' aOeS [�-l�i\:\s�-a-,y\L��,r�-c .ter li)(4 STS C,153 WO 14ti34 �V-'c\ -o l`6
<br /> c,c\a i i� Cac�c\Q �c s s ��C X"'tam a i s\c n w\Z\\4 44K ac 't-aLj - aft.k
<br /> Exempt Useekf Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricultural and Horticultural Society ❑Educational ®Religious ❑Charitable ❑Cemetery as indicated?
<br /> Give n of use,including an explanation it multiple use classifications exist: ®YES ❑NO
<br /> !!\\ ��h\C\ � Q, _ ,�� ,� Clt\ �6).\ �e\��.� II No,give percentage of exempt use:
<br /> `o
<br /> Q.v'Q.-s c ! .c\c.c.y :> \ ' .1,S-- tea. \\\chi
<br /> �C�resxv s�-���.r\,, vJ� ..�o ->;\:.3 V3r-, cs&�.\Ca\t.r�c�vJ ��R-
<br /> ` � @�Qr\C� C�. \ e.p�lowlhwc���r\ cd complete.
<br /> Under penalties of law,I eclare that I have examined this exemption application and,to the beslLLf my knowledge and belief,it correct and complete.
<br /> I also declare that I am duly authorized to sign this exemption application. 3� -\c' 6.\'y1
<br /> signer V, \`
<br /> W v,, t.R 3C:MO',wl.,) �Cl l4 (\!�j{,y1�
<br /> here I Authorized Signature Title Date
<br /> For County rrreasurer Recommendation I
<br /> $Approval Comments: X& (ye "'SS *-17-aock
<br /> ❑ Disapprofai z,. a . ,t r -
<br /> . ,.. . ,,� 1 btu - u fireosu.ce( ; /NIiK
<br /> t
<br /> 11 n ure of unty Treasurer Date
<br /> r
<br /> 1-F:^ 7 4 ^;i3 Fo County Board of Equalization Use Only
<br /> 4J Approval Comllnents:
<br /> r ___,
<br /> ❑Disappr Vat"`”' -- .__._ . .;n.
<br /> aL. i Cr
<br /> Aut •rized—g IT' - - -- Dalt
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stal.§§77-202(11(c)and(d),and 60-3.185.and 60-3,189
<br /> 96-253-2006 Rev.7-2019 Supersedes 96.253.2006 Rev.82011
<br /> Please retain a copy for your records.
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