Laserfiche WebLink
��---�-� A lication for Exemption � � � � FORM <br /> Ne6reska�epartment of �� <br /> ��NVE from Motor Vehicle Taxes by Dualifying Nonprofit Organizations 457 <br /> •To�e filed wlth your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicanc's Name Type of Ownership <br /> TRINITY LUTH�RAN SCHOOL �Nvnprofit <br /> Street or bther Mailing Address County Gorporation <br /> 2b$W 13TH S7 HALL �Other(speciiy): <br /> Ciry State Zip Code State Where Incorporated <br /> GRAND 15LAND N� 68$p1 NE <br /> IDENTIFY pFFICERS,bIRECTORS,OR PARTNERS OFTH�NONPRpFIT ORGANIZATIpN <br /> Title Name,Address,City,State,Zip Gvde <br /> �; ,� �- d 7 K d � b 8a/ <br /> � �� �- � 6 ga I <br /> r $ O <br /> '� Z NE P P�/ <br /> �' r S r � � <br /> DESGRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> " ^ - Registration Date or <br /> MotorVehicle Make ModelYear 6odyType Vehicle ID Number Dale of Acquisition, <br /> if Newly Purchased <br /> � <br /> �r .- <br /> i ... <br /> Exempt Uses nf Motor Vehicle: Are the motor vehicles used exclusively <br /> �AgricuHural/Horticultural �ducational �Rellgious ❑Charitable ❑Gemetery as indicated7 <br /> Give detailed descripfion of use,including an explanation if multiple use classifications exist: �'ES �NO <br /> �G�'lVi�/ ,�ic.s " �a.r�S�vY"��n q� �urclt q� <br /> ,��.�+.aa� mG.r�.6er.s �rn' `JQ�,u�'�%rS 4I,�.���� <br /> ��c z s �o�� <br /> Under penalties of law,I declare that I have examined tl�is application and that it is,to the best of my knowledge a belief,true,comptete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the abov listed proper F�i���e <br /> in membership or emplo ment based nn race,color,or national origln. A`^��� "�5 OF�10E <br /> L GRP.?dG P3i,.FJ•dr.i.Ni„�FCqKSA <br /> //� � � Ll..��RGO� _. <br /> SIg11 ���f �2 �� <br /> �"�e�� Authorized Signature Title �at <br /> FOR COUNTYTREASURER RECOMMENDATION <br /> �PPROVAL COMMENTS: s ���"�� <br /> []DISAPPROVAL .____ _ <br /> • �1�`�'�i,.�:, <br /> _ /a7-�9 --/ / <br /> Signature of County Treasurer Date <br /> � � FOR COUNTY BOARD OF EGIUALIZATION USE ONLY _ <br /> �PPROVAL COMMENTS: <br /> []DISAPPROVAL �..-.-..- <br /> Y.�"1 I� <br /> Authorized Signature Date <br /> Nebraska Departmenl of Revenue Authorized 6y Ne6.Rev.Stat.§§77-202(7)(c)and(d),antl 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.B-2091 Supersedes 96-253-2Pa6 Rev.5-2009 <br /> PLEAS�RETAIN A GOPY FOR YOUR RECORI75. <br />