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,wIf <br /> Ne�b.askaoep�rtm�entof 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 CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 212 W 12TH ST HALL ID 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 Cade <br /> Chairman Dan Harries, 118 Centennial Dr, Grand Island, NE 68801 <br /> Vice Chairman Dave Richardson, 221 E. ASHTON AVE, Grand Island, NE 68801 <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 Vehicle 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 /> ❑Agricultural*torticultural 111 Educational K]Religious ❑Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> . To bring church members to church and to take school children If No,give percentage of exempt use: <br /> to school activities. <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and beiiet,true,complete,and correct.I <br /> also declare t at I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in members or employment based on ce,color,or national origin. <br /> Sign , 'n//rvf//� Treasurer 11/11/2013 <br />•• <br /> here. i Signature /r// Title Date <br /> RECEN .• • • TREASURER RECOMMENDATION <br /> APPROVAL COMMENTS /"'/' ���"' � ' #77—�C\ <br /> ❑DISAPPROVAL NOV 2 Z <br /> 2013 <br /> -9cy X 9e 141 /:-to —eta/ <br /> HALL COUNTY • -• ignature of County Treasurer Date <br /> 1RCACURE'S fFFICE <br /> cRANO ISLAND 7:;.,- ...• - •ARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> ▪ /-1.4 in c _/</ //L <br /> Authorized Signature ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.StaL§§77-202(1)(c)and(d),and 60-a,185,and 603,189 <br /> 96-2532006 Rev.5-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />