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NFRDAS44A I Application for Exemption I FORM <br /> from Motor Vehicle Taxes <br /> by Qualifying Nonprofit Organizations Good Lde GreatSerc:ec. I <br /> 457 ua•At ENT orervr".vr 1 •R Rebe ad instructions on reverse•Reatl instructions on reverse aide. <br /> Name of Organization i Type of Ownership <br /> Trinity United Methodist Church 1 IX Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property 1 County Name I State Where Incorporated <br /> Trinity Methodist Church I Hall 1 NE <br /> Street or Other Mailing Address i Contact Name 1 Phone Number <br /> 511 N Elm I Susan Stoppkotte I 308-382-1952 <br /> City State Zip Code I Email Address <br /> Grand Island NE 68801 I trinity©trinityumcgi.org <br /> IIdentify Officers,Directors,or Partners of the Nonprofit Organization <br /> I Title Name.Address,City,State,Zip Code <br /> Trustee Chair I Gloria Gress,2220 20th Ave.,Central City,NE 68826 <br /> Trustee Herb Roeser,2316 Pioneer Blvd.,Grand Island,NE 68801 <br /> Trustee 1 Karen Reese,2123 W Koenig,Grand Island,NE 68801 <br /> Trustee I Joe Watkins,320 Ponderosa Dr.,Grand Island,NE 68803 <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> I 7 j Registration Date or <br /> I Motor Vehicle Make I Model Year ( Body Type Vehicle ID Number , Date of Acquisition, <br /> if Newly Purchased <br /> H&H Trailer <br /> I Trailer TTFTCA7x16 I 5KWTC1624JN02995 01/01/2019 <br /> I 1 1 I <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> Agricultural and Horticultural Society Educational Religious as indicated? <br /> 9' y ® g ❑Charitable Cemetery <br /> Give detailed description of use,including an explanation if multiple use classifications exist: g YES ❑NO <br /> Trailer used to haul supplies (tables&chairs)to Loaves& Fishes Food Bank, monthly free <br /> If No,give percentage of exempt use: <br /> giveaway of food for 350 to 450 families in Grand Island. <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 els declare that I am duly authorized to sign this exemption application. <br /> sign �` 4 _) /a- q�fl <br /> here Authorized Signature Title Date <br /> For CountyTreasurer Recommendation <br /> ke pp royal -EG= i <br /> ii // ments: <br /> t) V' {\ - ma <br /> y <br /> ❑Disapproval <br /> 18 Q(114L 'VAA11•1/��/.�1l1y0k.� Yar\\1��$ <br /> Signature of County Treasure Date <br /> I _HALL COUNTY For Coun Board of Equalization Use Only <br /> • <br /> ^F=r/OE <br /> GRAND ISLAND, NEBRASKA <br /> Approval Commen s: <br />• ❑Disapproval ' / / <br /> a ai - (V/ V <br /> Aut)orize. '_ : u-r Date <br /> '\ / <br /> Nebraska Departrnenl of Revenue Authorized by Nell Rev.Stat.§§]7-20211I(o)and(d).and 603.195,and oea109 <br /> 9€-253.2005 Rev.?-201e Supersedes 96253.2006 Rev.02011 <br /> Please retain a copy for your records. <br />