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076 <br /> asten.----z,— • Application for Exemption FORM <br /> Nebraska 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 /> filir pplicant'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,State,Zip Code <br /> Lfhulrnwn enn Qal'on AA {lorries In &liei). a/ br. 6ratdIs/a,ad. WE. bb'8of <br /> Treasursr -pr. Tammy - 7/9 w. 7a 5f, u // <br /> i t - 1 i • / e. • .�6 N N .. N/ <br /> 1 <br /> .L/ J ? t. / 4., r• <br /> -M <br /> le 1. , I <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 /> V./Lit 63rd zoos gas Vision 18A (Pcleii22C151252. <br /> Exempt Uses of Motor Vehicle: ,/ Are the motor vehicles used exclusively <br /> ❑Agricultural/horticultural tducational 'Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: S LINO <br /> L <br /> e0 n If No,give percentage of exempt use: <br /> Cii <br /> iici V1 &LS - Ta nspor in7 C iwrck ail- <br /> Sehn/ n'leen,ars acts ✓itI e5 <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 /> 77-in 'V7 LccfAe.ean cj oo/ <br /> sign dpi 4,„,,,s4„,,,,), �r;,tai.1 1/ -//- /3 <br /> here 'Authorized Signature Title Date <br /> ruR COUNTY TREASURER RECOMMENDATION <br /> RECEIVED <br /> APPROVAL COMMENTS: <br /> ,/Cdtt'7ta r y'.arS1 a5 'd am 4zic..2- <br /> ❑DISAPPROVAL NOV 1 C 3 3 <br /> rt6 ` <br /> HALL COUNTY Signature of County Treasurer Date <br /> - TREASUPFAS Oc1Ce <br /> GRAND ISLAND,NEBRASIStR CQUNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> 6t At c- / a <br /> illAuthorized Signature ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat.§§77-202(1l(c)and(d),and 60-3,185.and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />