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�,o��— <br /> ��� Applicativn for Exemption �o�M <br /> NeGraska Depertmen[of <br /> �C�N' rC from Mator Vehicle Taxes by Glualifying Nonprofit Organizations 45,7 <br /> RG V G •7o be filed with ypur county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> TRINI7Y LUTHERAN CHURCH �Nonprviit <br /> Street or Other Mailing Address � County Gorporation <br /> 2�2 w �2rM s-r HALI�. <br /> �pther(specify): <br /> City State Zip Code State Where Incorpprated <br /> GRAND ISLAND NE 68801 NE <br /> ID�NTIFY OFFICERS,DIREC70RS,OR PAR7NER5 OFTHE NpNPROFIT ORGANIZATIpN <br /> 7itle Name,Address,Gity,State,Zip Code <br /> Chairman Dan Harries, 11$ Centennial Dr Grand Island NE 68801 <br /> Vice Chai�rman A1 Knoe fel 42,7 Halcomb Grand Islan <br /> Secretar Lee Hazen, 1428 N Rub ,Grand Island NE 688�1 <br /> Treasurer Tazumy Beers, 719 W 7th 5t, Grand Island NE 68801 <br /> rustee- hai� r a arry Wx ton, Airport Roa , ran Is an E <br /> DESCRIPTION OF THE MOTOR VEHICLE5 <br /> •Attach an additional sheet,if necessary. <br /> --'-- "" Registration�ate or <br /> �lotorVehicie Nlake ModelYear I BoayType Vehicie IU Number Pate ot Acquisition, <br /> if Newly Purchased <br /> Dod e 961.56Q$OQ25 1995 _,_I_Van 2B5WB Z8SI� 61800 <br /> � -�9�9$- 1 2 <br /> StarTrans Ford 2002 Handica Van bus 1FDXE45S22HA70066 <br /> 2 Wheel Util Trlr 1990 Home�made N A <br /> 2 Wheel Util Trlr 1970 Homemade N A <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> �Agriculiural(Horticultural ❑Educational �Religious �]Charitable �Cemetery as indicated? <br /> Give detailed description ot use,including an explanation it multiple use classifications exist: �YES �NO <br /> To bring members to church and to take schopl children to If No,give percentage of exempt use: <br /> schppl activities ���P�� r�R <br /> rv u <br /> �ov 2 2 zoa� <br /> lJnder penalties of law,I declare that I have examined Ihis application and that it is,to the best of my knowledge and beli f,true,complete,and wrreCt.I <br /> also declare that I am duly authorized to sign this exerc�piion application,and that the organization owning the above-liste property does no����ir�r�TM <br /> in membershi or employment based on raa olor,or national vrigin. 7REASURER3 DFFICE <br /> � GftAyD ISLAND,N�E3RASiCF1 <br /> sign � A _l <br /> here Authorized Signature Title Date <br /> W FQR COUNTY TREASURER RECOMMENDATIpN <br /> �APPROVAL COMMENTS: � ����a°�' <br /> ❑DISAPPFtOVAL <br /> �� asi� <br /> Signature of County Treasurer Da e <br /> FOR COUNTY BOARD OF��UALIZATION USE ONLY <br /> �PROVAL CbMMFNTS: <br /> ❑DISAPPROVAL ---- <br /> � ������ <br /> 1 <br /> Authorized Signature �ate <br /> Nebraska l7epartment of Revenue Authonzed by Neb.Rev.Stat.§§77-202(1)(c)end(d),and 60•s,785,and 60-3,189 <br /> 96-253-20�6 Rev.8-2011 Supersedes 96-253-20p6 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />