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X0/3 <br /> imon..---enfaf Application for Exemption FORM <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 SCHOOL ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 208 W 13TH ST HALL ❑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,Stale,Zip Code <br /> .(194044•10.A. (9R9n9¢ / n. ! It. 4arries lit Coniermilbr. 6randT/and AM 19.18a keno-ern- o9regalion <br /> /Qlmmr 1 ers 7/9 ld. 514-...0. Giaaal:/awd Alt b8frol <br /> e el Lee •:e A . •'- ., :- _ -Ad VE 0. g <br /> _ 1 i t . .�. rs;fl "O W. . .. grad Jr tl draadls/a.td,Ng H843 <br /> r • - - tv [ i•n 3S £. iir•id-R, . - l.' , ,$O <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 Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> ,/4/tnSreL 2..0 OR Bits Vi sin. /tACDCKt/ 28ft`25125i <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural "ducational 12<eligious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed dscription of use,including an explanation if multiple use classifications exist:/ ) YES ❑NO <br /> • Sees - Trans or el" erg(trek &it Ot If No,give percentage of exempt use: <br /> Schwa/ m ern lets -,Gr G2c i vi•,Li'e. <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 /> /ink membership or mployg moot based on race,color,or national origin, <br /> //ter el/-/s' L/d_'v/rJ1!_/.ca-. VL_.raeA'1/ <br /> sign r 12 18-1 z <br /> ue here it A Sign& <br /> Title Date <br /> �p <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ®APPROVAL RECEIVED COMMENTS: "1"—CS 77.-090.2.-.. <br /> ❑DISAPPROVAL <br /> DEC 1 3 2012 <br /> I►Signature of County Treasurer Date <br /> PNLL COUl"TY <br /> TRFASURERS OFFtf. R COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ante._,,.,_,rrvv,ntSRrn3rA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> —A 0 <br /> • thonzed Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-2020)(c)and(d),and 60-3,185,and 603,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />