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erekeDMat Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> onnlinn •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 Na fe,Address City,State,Zip Code <br /> ■`u' 7tRrhia!•1� 1 r ie71,'.0 i �YA�.7l`v ii. 71 ri'.�J�'.�'l��'rTt?Romar an pC/ <br /> a t raisaseararsnarmit4ra .ula1>tromerrairfrtmi <br /> Ariz. ii7.titrassfrfi:IP►R1i r :►�1 t ari^►a t . tattastar!f�%Chia <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 /> I if New ^.--`-- <br /> uTniE4 W1�!I1rAME iZ aW> a�� 1tttZ itlilliSC'V <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriahurabHortcuaurai ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multi Is use classifications exist: YES ❑NO <br /> k> ckc .i 1 j4i S U•\ VI✓ 1 u t(S If No,give percentage of exempt use: <br /> 't ebb&ls Uthevtrr(Nrn Th P u% fr 1/4(5 <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 mem•- - ip or employment based on ce olor,or national origin. <br /> sign ,`n N Ititithe- <br /> r 1;rtv ' ` O!`/ <br /> here 'Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION 77-4-74%.2._ <br /> (1PPROVAL RECEIVED CO h VENTS: /�~ 04/..o,5":45.. <br /> ❑DISAPPROVAL V <br /> DEC 3 2014 L ` /-9-i3— <br /> Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUN r/ <br /> TREASURERS OFFICE <br /> T APPROVAL GRAND ISLAND,NEBRASKA rnyMENTS: <br /> ❑_DISAPPROVAL <br /> /art n ate/ 3 --1 S <br /> !thod ed Sig afore - <br /> Nebraska Department of Revenue Authorized by Neb.Rat.Stat.§§77-2020)(e)and id).and 60-3185,and 60-3,189 <br /> 98-2632006 Rev.8-2011 Supersedes 96253-2036 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />