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Application for Exemption fitp F�M z <br /> Good Life.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> w..e.�...er � <br /> •To be filed with your county treasurer. 457 <br /> •Read instructions on reverse side. <br /> Name of Organization 'Type of Ownership <br /> Third City Christian Church ®Nonprofit Corporation ❑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 Lp Code Email Address <br /> Grand Island NE 68803 carolyn @thirdcitychristian.org <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> This 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 Rudman,2640 N.North Rd.,Grand Island,NE 68803 <br /> Description of the Motor Vehicles <br /> *Attach an additional sheet,if necessary. <br /> Registration Data or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> International-IC 2005 Bus 4DRBUAFP45B979438 <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 ndescription of use.including an explanation t multiple use classifications exist: r�YES ❑NO <br /> ///{'f „//„ i l %t1 A-r i C ` If No.give percentage of exempt use: <br /> sty 7 i� 'Gfol y asi & G,kcua . <br /> Under of law,I that I have examined this application and,to the best of my knowledge and belief,it is comet and complete. <br /> I da <br /> also dada,- t I em duly to sign this exemption application. <br /> sign •)--y —//r <br /> here ■iethorize Sig re Title Date <br /> For County Treasurer Recommendation <br /> Approval Comments: <br /> ❑Disapproval <br /> It Signature of County Treasurer Date <br /> For County Board of Equalization Use Only— <br /> Approval Comments: / <br /> ❑Disapproval <br /> • <br /> as <br /> R"�-A =. 9L•�e'� _ _-- -Date _ <br /> Nebraska D9paranent Cl Revenue Authorized by Neb.Rev.Stat.f477-202(1)(c)and(d).and 60-3.185,and 804189 <br /> 96-253-2006 Rev.7-2018 Supersedes 96-253-2008 Rev.8-2011 <br /> Please retain a copy for your records. <br />