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Na Application for Exemption FORM <br /> Good Lie Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be filed with your county treasurer. 457 <br /> DEP•PTM'"'°G°°EavE •Read instructions an reverse side. <br /> j <br /> Name of Organization Type of Ownership <br /> SPIRIT OF LIFE CHURCH El Nonprofit Corporation Other(specify): <br /> Name of Owner of Property County Name State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Corftact Name <br /> Number <br /> 2304 MACRON ST /f A Fr tare/r. 3er BSD 319 A <br /> City State Zip Code Email Vdress LL <br /> GRAND ISLAND NE 68803 v )4i/ 5-osvt D //OjNter 1` COM <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization 7 <br /> Ti�tlee i I . ,[ Name,Address,City,State,Zip Code �J 1 p jy <br /> !/lit 144O4/�n _zee 4Rk'Csat Dv 4.r pig' b / - -zil-At.r Hrrei <br /> SSf✓.e h&V eee a 11 G 1%✓ 4f /t!E /pfl l Vp lllBe r� <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,it necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> CK 1S *n� S VAh f Newly Purchased <br /> Key ^ <br /> j 1 C-AZitFe'762- f£711£r <br /> a <br /> Exempt Uses of Motor Vehicle: - <br /> Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society Educational eli bus as indicated? <br /> ❑ 9 Ill ❑Cemetery — / <br /> Give detailed description of use,including an explanation if multiple use classifications exist: 1 r ❑NO <br /> '0rfz kr kt/t /ypat- Gt/er kvd, oo <br /> I ,F ( ✓ No,give percentage of exempt use: <br /> U W8tlial nc-tk &..-1-k1 -lily 4 <br /> Under penalties of law, declare that I have examined this exemption application to the best of my knowledge and belief,it is correct and complete. <br />• <br /> I also t ire that I fit ed to sign this exemption application. <br /> {sign <br /> aa pp r�L)) <br /> aiLAV!late , rize Signature Tilly i23/�/l/ <br /> Date <br /> ,-,!1 p�+r� �vr�. For County Treasurer Recommendation <br /> VJ gpproval I1 CEI� L®mment . . .tom.0/ L S Ilhl� <br /> ❑✓Disapproval <br /> DEC, ,-,8 VALth <br /> Date <br /> HALL COUNTY For Cou ty Board of Equalization Use Only <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NESR SKA <br /> '�Approval L,Urunient <br /> ❑ Disapproval r-----71- <br /> k °ed atu Dat <br />• Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3.185,and 60-3,199 <br /> 96-253-2006 Rev.7-2018 Supersedes 96-2532006 Rev.8-2011 <br /> Please retain a copy for your records. <br />