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L 1 <br /> R <br /> lc ta <br /> A A Application for Exemption Pa FORM Z <br /> Good Life.Great Service, from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> •To be fled with your county treasurer. 457 <br /> 00■111•e1T••AMNIA •Read instructions on reverse side. <br /> Name of Organization Type of Ownership <br /> Third City Christian Church ®Nonprofit Corporation El Other(specify): <br /> Name of Owner of Property County Name State Where Incorporated <br /> Hall NE <br /> Street or Other Mailing Address Contact Name Phone Number <br /> 4100 West 13th Street Carolyn A. Michael 308-384-5038 <br /> City State Zip Code Email Address <br /> Grand Island NE 68803 carolyn@thirdcitychristian.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> The Name,Address,City,State,Zip Code <br /> Elder Chairman Larry C.Gerdes,2510 Parkview Dr.,Grand Island,NE 68801 <br /> Treasurer Marvin Duryee,8437 W.Woodriver Rd.,Wood River,NE 68883 <br /> Secretary Gerry Ruttman,2640 N.North Rd.,Grand Island,NE 68803 <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,H necessary. <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Registration q Date n, <br /> Acquisition, <br /> If Newly Purchased <br /> Ford Econoline Wagon 15 Passenger 2003 Van White 1 F85531S43HA47093 <br /> Ford Bus Chassis Cowls B600F 1990 Bus 1 FDNJ65P6WA12040 <br /> Freightliner Chassis FS65 2001 Bus 4UZAAXBW11CH56883 <br /> freightliner Chassis FS65 2003 Bus 4UZAAWCT83CK65855 <br /> Freightliner Chassis FS65(Thomas70 2003 _ Bus 4UZAAWCT63CK65854 <br /> Exempt Uses of Motor Vehicle: -Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ❑Educational 1,1 Religious ❑Charitable ❑Cemetery as Indicated? <br /> /.. use,including an explanation if multiple use classifications exist: ®YES ❑NO <br /> /!!A. re ry '/D' ,� ct it '�'u4t4 If No,give percentage of exempt use <br /> UWe _� YVItii:jemeAHVeketter!/,teM ✓✓RaZ ni r r _', _ Q ply, �7 % <br /> Under.: of law,7'redare that exam this exemption application i/� •knowledge and belief,It is correct and complete. <br /> I also•_•- �� I am duly autho d to sign this exemption application. <br /> sign ', � �-� !� <br /> here ,Authorized Signet - Title Date a -/��f1—" <br /> For County Treasurer Recommendation <br /> ' r/ <br /> Approval RECEIVE&mments: Snip+ M $ -b <br /> ❑Disapproval 1■f L/ 1 <br /> DEC 1 3 2018 i is _ :.a'.. 1 • II ft.,.. J. /4/3/i8 <br /> signature; • Treasurer Date <br /> HALL COUNTY For County Board of Equalization Uss Only J <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> yiApproval Comments: <br /> ❑Disapproval . alir <br /> /3 `r 1 / <br /> i.netu Da r <br /> Nebraska Department d Revenue Authorized by Neb.Rev.Star§g 77402(15c)and(d).and 803,1a5,vat e43.189 <br /> 96-253-2008 Rev.7-2018 Supweedes 98.253-2008 Rev.8-2011 <br /> Please retain a copy for your records. <br />