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DEC/04/2015/FRI 03:45 PM P. 002 • <br /> Ne ae ,dne�er Application for Exemption FORM <br /> REVENUE • from Motor VehicleTaxes by Qualifying NonprofitLOrganlzatlons 457 <br /> .TO tie flied with your county treasurer. <br /> •Read Instructions on reserae side. <br /> Applicant's Herne 'type of Ownership <br /> PEACE LUTHERAN CHURCH OF GRAND ISLAND, NE, INC 2]Nonprofit <br /> Street or Other Meitng Address Cony Corporation <br /> 1710 N NORTH RD HALL ❑Other(specify); <br /> City State Zip Code State where Incorporated <br /> GRAND ISLAND NE 68803 NEBRASKA <br /> . IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS WIRE NONPROFIT ORGANIZATION <br /> The Name,Address,Cdy,Stale,Zip Code <br /> CHAIRMAN MIKE NELSON,330 SALEM RD,BOELUS,NE 88820 <br /> VICE CHAIRMAN ELAINE NELSON,1120 SAGEWOOD AVE,GRAND ISLAND,NE 68803 <br /> SECRETARY RICK HULS,4247 KAYE AVE.GRAND ISLAND,NE 88803 . <br /> TREASURER BOB BERAN,4238 SUMMER CIR,GRAND ISLAND,NE 68803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary <br /> Registration Date or <br /> Metorvehlde take Model Year BodyType YNack ID Number Pa�yp o , <br /> If swn <br /> MFG ENC TRAILER-4WH-RED 1991 XTXU 87726 JULY 5,2015 <br /> Exempt Uses of Motor Vehicle; .. Are the motor vehicles used exclusively <br /> ❑AgricW ufabtlOrdtWWral ❑EdUcadonal Religious ❑Charitable ❑Cemetery as Indicated? <br /> Give detailed deception of use.Including an explanation if multiple use dats,T,sabOM eft tg YES 0 NO <br /> Trailer will be used to haul equipment and materials used to help members fulfill our mission B moire percemage of exempt tea: <br /> which is to bring the word of Jesus Christ to residents of Grand Island and Hall Count. a. % <br /> Peace Lutheran is a religious organization;b. The trailer will be used exclusively for religious <br /> purposes;c. The trailer is not owned or used for financial gain or profit to either the owner or <br /> users;and d. Peace Lutheran does not discriminate to membership or employment based on <br /> race,color,or national origin. <br /> tinder mass of taw,I dictate?Sst I have examined this eppticsaon and that It e%to the beet d my Imowledge end Wet,true,complete,and ootrest.I <br /> also declare that I em duty authorized to sign this exemption epRwdon,and that the organization owning theabove4med property does not discriminate <br /> m membershp�'jmenl Weed e,Odor,or Mtlpnd origin. Al 7,y ?I e° <br /> sign fTT7REA,SaUIRHR�(/" 12-04-2015 <br /> here► 6lg a Tale Data <br /> I FOR COUNTYTREASURER RECOMMENDATION I <br /> IPPROVAL RECEIVED COIMENTS: n' A ' A%4' 7" °.2.0 <br /> ❑DISAPPROVAL e SP DEC fl 2015 " /W-/d - m-5- <br /> OP Signature of County Treasurer Date <br /> HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TrccAS'RCRS 9FnCE <br /> ,..,y GRAND ISLAND,NEBRASKA <br /> pd APPROVAL COMMENTS; <br /> D DISAPPROVAL <br /> :ice/,' ,� . /r' - 97e$12 <br /> rkbresNa d.p+n^ent et Hess AWIa'aad by Nea Rw.ataL ti 77.502(1)0)end NI,e d WWe,tea,and WAIN <br /> 90-253-2008 nee 5-ad 19urenedac g5-eesa006 FS.SON <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />