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iren.—_-- Application for Exemption i O <br /> Nebraska Department of !� FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> 6' 'fl •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> ST PAULS LUTHERAN CHURCH ®Nonprofit <br /> Street or Other Maifng Address County Corporation <br /> 1515 S HARRISON ST HALL <br /> ❑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 /> %reside./c-t[ i St4-./ <br /> . 626, tb V nt 66W <br /> U Atte. ic- % 7,e,n$z9 1vy d9Q/ <br /> -. c e re-.r l7/ /1 3 i z narsc : b£e <br /> O/ <br /> Tecaa e-r " / m >e &9/,S itc> <br /> mod. C-221 'e' 3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Typo Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> � wya6.. . ae� - TAt /7e z <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational NO Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed desorption of use,including an explanation if"mu"ltiple use classifications exist: spYES ❑NO <br /> /d5 t{rt/ZsdhUn (A'5f�5 — P ncI tit <br /> �' If No.give percentage of exempt use: <br /> G/scyskrs 5f,�r�eGs �tps dcuntfrs % <br /> Si. /uu/s (h,/de 'e 4.-/ft achetil &fit <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 <br /> _.z_ ,,,_ii-- -.. i _ l99/.0 <br /> her talleAuthonzed Signet are Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION G <br /> [L]APPROVAL COMMENTS: .��/"`"'y'r fps�" � `1 A.77-ac <br /> oJOot fRos0 <br /> ❑DISAPPR VAL RECEIVED y � � ��-„‘_i.5_ <br /> NOV 2 3 21015 /Signature of County Treasurer Date <br /> FOR OOUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> 0APPROV L TREASURERS OFFICE COAMENTS: <br /> GRAND ISLAND,NEBRASKA <br /> ❑DISAPPROVAL • .i :i�” e , ,,.ef ._ 24 oiS <br /> 9" !SP;tu : lr. ' Dat <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet.55 n-20a(1)(c)and(d),end 603.f8&and 803,189 <br /> 96-253-2006 Re..8-2011 Sxgersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />