Laserfiche WebLink
r_ 'aid <br /> ili --,,,„- 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 coumy treasurer. <br /> •Read instructions on reverse side. <br /> "'Applicant's Name Type of Ownership <br /> HEARTLAND LUTHERN HIGH SCHOOL ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3900 W HUSKER HWY HALL Eli 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 /> tr Gina e o r . •A — :T;• <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 /> -Altar j, ,s-r—li n111111r0 I v. • _ <br /> . e :..• i rs .aVillgrniinrin <br /> L. . ro lr�' WWI 147'1•111 .. • 1''.1111111111 3&V& l , '9 & owl s _ <br /> Exempt Uses of Motor Vehicle: / Are the motor vehicles used exclusively <br /> ❑ ,�, <br /> Agricultural/Horticultural 2/Educational Educational ❑Religious El Charitable 1:1 Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: DES ❑NO <br /> /ranS po rli ii 340 <br /> eivf If No,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 /> sign , u 'tj�0rk_i ga 'eeper //-/y 13 <br /> here I Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOM MENDATTIIOON <br /> 7�LPROVAL RECEIVEDOME,TS: REREa,REt / 4'a .c � <br /> ❑DISAPPROVAL NOV 1 8 2013 <br /> L.-or-4W�,`c - 'a- / `ice` <br /> /Signature of County Treasurer Date <br /> hSLL S COUNTY BOARD OF EQUALIZATION USE ONLY <br /> OFFfQo <br /> TREASURERS OF F <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> JLt (-L /-747,1 064c <br /> • Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet.§§77-202(1)(c)and(d),and 60-3.185,end 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 />