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010/7 <br /> etf Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 4�7 <br /> •TO be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> ST PAULS LUTHERAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1515 S HARRISON ST HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> ,P/.rne/L C HA//)14ai1 t/tzr; eve ZL'9 0 SG -,,?Si; - es41", e - ii// <br /> 11104t/701._ ihn9-ifia'44 ff/C 44-),QP,I2. 3c57 XU /s,;'&ir-c .-Lx O I.5'M Lysol= <br /> OctalCft TdeafaP2 Fan P'EPA.a.-7 3//s-,-/-P..>>u'C'ci /'/p' 6tacrv/�sI��Ut4' av/ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> _ _•Attach an additional sheet.if neceasary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> it Newly Purchased <br /> 'Mir/ `TID <br /> A' e,00 7 la yZ c2 3G/7.S'/-W242_ <br />• <br /> • <br /> - <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> E A riculturaUHorticultural 0 Educational VI Religious ❑Charitable ❑Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: i EgYES ❑NO <br /> • ` gaff Z/ n d� / / <br /> la �1 p C t-A.ate c 4 4'C7L/U",Ite,f /de tio If Na,give percentage of exempt use: <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 membership or employment based on race,color,or national origin. <br /> / `� <br />.._ here �+�`Ay ///�� '�- %/.?�'��z�t- //-k-.-/.. <br /> hor>ized lgna u're Title Date <br /> RECEIVE COMMENTS <br /> TREASURER RECOMMENDATION <br /> c- ir 7/' C <br /> APPROVAL o COMMENTS <br /> ❑DISAPPROVAL NOV 8 2013 <br /> - X /-� - >� <br /> HALI_COUNT/ I'Signature of County Treasurer Date <br /> TleFASt iRFRS OFFICE <br /> GRAND ISLAND.tM@KMry WARD OF EQUALIZATION USE ONLY <br /> IQ APPROVAL COMMENTS: <br /> ❑DISAPPROVAL �--� ��/i <br /> • /Authorized Signature --- ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.077,202(1)(c)and(d).and 60-3,185,and 603,169 <br /> 96-253-2006 Rev.5-2011 Supersedes 96-253-2006 Rev.5-2009 <br />• <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />