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PI lig <br /> qie — 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 /> Applicants 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 OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> �Qirryte /'6n ry ais:w w ties /l£ 'jnfrnnial At, Gana,/ bnJ Alt 62101 <br /> tee C/ainms fit l-m,, Ns ,eAaasn 221 . AsA-4 •t a ar <br /> TitAftrrar ate Tann &ers 9/9 Pi, a rr r r <br /> Cturta" Titsfees clehr Ne in /4/3/ 4Pa Rd Cf naa <br /> we 6;88Z7 <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 m Number Date al Acquisition, <br /> if Newly Purchased <br /> dluettrd *St ag BUS Vision /$AK be K1-1 23 F 2S12SZ <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agriwltura9Horticultural Q�ucationel <elig ous ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanafion if multiple use classifications exist: [ 'YES ❑NO <br /> If No,give percentage of exempt use: <br /> itleihidy gas - Transpor /y sohaal s4cc/t -/-s Q d % <br /> Marc/. /dent hers )0 (QC+Wyyi /xes <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 properly does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> T,.4 At ra Sahoa/ <br /> sign .��_,�, i t. ,iii Principal /l -12-/5/•here hut oozed Signature Title Date <br /> �pq° �"gory/ FOR COUNTY TREASURER RECOMMENDATION`, I <br /> [M}ARPROVAL • `ECEI\I a+ COMMENTS: ��-" /�"— g, .41-- � <br /> ❑DISAPPROVAL NOV 1 4 2014 <br /> X&Aa=-st /--9-/S <br /> Signature of my Treasurer Date <br /> r HALL COUNTY <br /> TREASURERS OFFICEFOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> GKANU ISLAND,NlzbKASKA <br /> .r APPROVAL COMMENTS: <br /> ❑DISAPPROVAL �a <br /> I//✓�e ///J its/3/� <br /> Au`oozed Signs P- <br /> Nebraska Derailment of Revenue Authorized by Neb.Rev.Stat.$$77-202(1)(c)and(d).and 80.3,185,and 603.189 <br /> 96-253-2008 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />