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<br /> TO BE FILEDWIT'H Application for Exemption �o�M
<br /> YOUR COUNTY from Motor Vehicle Taxes
<br /> TREASURER bY Qualifying Npnprofit Urganizations 457
<br /> •Read instructions on reverse side
<br /> �..... , _,._....�._... __. �.._.�......�................�,.
<br /> Applicant's Name County Type of Ownership
<br /> Weartland Lutheran High School _ � Hall �Nonprofit
<br /> Street or pther Mailing Address County Number Corporation
<br /> 3900 West Husker Hwy. x-'E a
<br /> _.�.,..._ �.,. ----.. _._ __. ❑Other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> Grand Island NE 68803 I Nebraska --
<br /> __�._.__
<br /> Idc3ntify Officers,�irectors,or Partnars
<br /> _.._ _ __. .,— .._.._--
<br /> Title Name,Address,City,State Zip Code
<br /> --- _ _�__.._—, _.,.__ ._..... ,
<br /> Executive Director/Principal Rev.Kurt Busskohl,4164 Norwood Dr. Grand Island,NE 68803
<br /> ..,....._ —.._... _... —_.._ .. _ ,.....,.. . _.._.... �......,.,. ....__..._
<br /> Board of Directors Chairperson Shawn Messersmith,2916 W Nprth Front St Grand Island NE 68803
<br /> ---._......._...___.._ _. —....._..._,
<br /> Vice-Chair.Brd.of Directors Michael Hutchinson,213 Apricot Doniphan,NE 68832
<br /> � , .. --,_.,.,.�. —_ ._�...-- --._. �......_ .... ... �
<br /> LIST SPECIFIC pESGRIPTION OFTHE MOTOR VEWICLES
<br /> •Attach additional sheet if necessary
<br /> w ..._ — _.. ......-- —
<br /> Registration Date or Date
<br /> Vehicie Make Model Year Body Type Vehicle Identiiication Number of Acquisition if Newly
<br /> ---..,......., _....,_. _._....�.... __ Purchased
<br /> _. ... -- ---....._..___._.....�,,..,,.._ ......................
<br /> Ford 2000 E150 1 FDRE14L9YHB48613 5-2'7-11
<br /> _ __......._ ---.._. __.._........— -- -----._..._. _........., _..._.—
<br /> Nature of Use of --- — . ~ _ � �mm _—_
<br /> Motor Vehicle: Are the motor vehicles used
<br /> �AgriculturaUHorticultural ❑X Educational �Religious �Charitable �Cemetery exclusively as indicated?
<br /> Give det�iled description of use,including an explanation if multiple classitications exist: �YES �NO
<br /> This van will be used to transport students, sponsors,coaches and teachers to various
<br /> events that Heartland will participate in. This would include athletics, activities [such as NQ,give p � �
<br /> speech, music, drama, etc]and similar events. ._. __,
<br /> This van will not be used in bus route transportation as we do not run bus routes.
<br /> � �� .
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<br /> com lete.i alsa declare that I am duly autharized to si n this ex -- -- ------�_.._....._. -----...._.. �.._..._.....__,..T--.---- '
<br /> Under penalties of taw,1 daclare that i have examined this applicatinn and,to the best ot my knowledge a helief,it is cor�pFJ1V7y
<br /> P g emption application,and that the organization owni g said prop��RS pFFICE
<br /> discriroinate in membership or employment based on race,color,or national prigin, ��NP ISLAN►�l,NESRAKSA
<br /> .
<br /> s�g n �'����4��L a�n-��:��� � 7 ���
<br /> �.� _ ...... . .
<br /> here �thorized Signature Title Date
<br /> �_..._ _ __.--.._. .....__...._..._._. . ._
<br /> _ FOFI COUN7YTREASUR�R'S R�COMMENpATION
<br /> [�APPROVAL GOMMENTS: �`! �"� 1 �� ��°L
<br /> []DISAPPROVAL _.,.... _.
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<br /> ! �. � -i.3 - Il
<br /> � : ����
<br /> i Signature bf County Treasurer ^�FT �ate T�
<br /> _.._..__ _............. __. ...__........__ . _,._......_�._ ..��.._......,._..._r ,...�
<br /> FOR COUN7Y 60ARD OF EQUALIZATIDN 11SE ONLY
<br /> �......,�_-______ �....,. _.._ -- - ---.....�_....._...,_ _�._
<br /> �J APPROVAL COMMENTS: �.,...,_.__.
<br /> ❑DISAPPRQVAL _.T__.._.._.... .............. �
<br /> `_ .. • „(c.` .�/ e��//
<br /> Authorized�ignature Oate �
<br /> Ne6raska Department ol Revenuc �� � ������ �AUthorizad by Neb.Rev.Stat.§77-202(t)(c)(d),§60-3,185§60-3,189
<br /> 96-253-2006 Rav.5-2008 Supersedes 96-253-20�6 Rev.11-200$
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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