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c2013 <br /> y • <br /> Nen --L- Application for Exemption FORM <br /> braska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> • TRINITY LUTHERAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 212 W 12TH ST HALL <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Chairman Dan Harries, 118 Centennial Dr, Grand Island, NE 68801 <br /> Vice Chairman Al Knoepfel, 3990 W. Capital Ave #221, Grand Island, NE 68803 <br /> Secretary Lee Hazen, 1428 N. Ruby, GRAND ISLAND, NE 68801 <br /> Treasurer Tammy Beers, 719 W. 7th St, Grand Island, NE 68801 <br /> Trustee-Chairman Larry Wilton, 235 E. Airport Rd, Grand Island, NE 68803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type . ID Number Date of Acquisition, <br /> - - - - - - -- - - - - if Newly-Purchased <br /> Dodge 96156080025 1995 Van 2B5WB35Z8SK561800 <br /> StarTrans Ford 2002 Handicap Van/Bus 1FDXE45S22HA70066 <br /> 2 Wheel Util Trlr 1990 Homemade N/A <br /> 2 Wheel Util Trlr 1970 Homemade N/A <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> El AgriculturalHoniculiural ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: OYES ❑NO <br />• <br />• To bring members to church and to take school children to No,give percentage of exempt use: <br /> • school activities r <br />• <br /> . Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in member ip or employment based on race,color,or national origin. <br /> sign <br /> Treasurer 11-03-7017 <br /> here Authorized Signature Title Date <br /> I =OR COUNTY TREASURER RECOMMENDATION I <br />• <br /> RECEIVED ,mss <br /> �APF ROYAL COMMENTS: /may <br />• <br />• <br /> ❑DISAPPROVAL av - ' 2012 (;?..e4,23,4 <br /> HALL COUNTY <br /> .� .7� <br /> TRREAS LIRE RS OFFICE / K //Signature of County Treasurer Date <br /> Gr«,err I'._ND,rvr=ercr+ iGV FSR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> .APPROVAL COMMENTS: <br />• <br />• ❑DISAPPROVAL <br /> • „......e‘ r •ter.' i-AS —ria 4 <br /> uthorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev Stat.§§77-202(1)(c)and(d),and 603,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />