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• <br /> mn---,..----z - Application for Exemption (77076:7 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 /> amorrinism •Read Instructions on reverse side. <br /> Applicants Name Type of Ownership <br /> TRINITY LUTHERAN CHURCH ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 212 W 12TH ST HALL <br /> ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> O-n.i mart Coruyret-on Gag SptrtanSW - 3c c 3rerrrwcccl 'RAN A (Beano \sk ac\ NC be8o I <br /> '4;aclnAirvl- - CDn ve otlL�o.-ve_ 9,tctic:rdson - Qat E fl54r,on wand \l\av1k tJE. (o 631 <br /> TreaSUrer g iamm9 Beers- '1\°9 W 'MA Sr. taxsdt \Stair NC \eBBO1 <br /> Chit r for ThASteeS ,-ION(W) Stim - \431 t-}Z+t (zd 1 NE to88a7 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Oats or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> _ Dra 11,45 Pam \Ne5on atob 2g5v4 855255Kto 18op , <br /> Ford aoo-a Cu-10-s6a \tan £450. 1FLoiE4SsaahQlloka„ <br /> Exempt Uses of Motor Vehicle: J Are the motor vehicles used exclusively <br /> ❑AgdahuratiHortcuttural ®Educational Religious ❑Charitable ❑Cemetery as nd sated? <br /> Give detaled description of use,Including an explanation If multiple use classifications exist: (RYES ONO <br /> Lased far -1Ya nS x)r-h nq t tu,r oi\ 0-no\ SG1r1e0 I If No,give percentage of exempt use: <br /> v <br /> meMbel far act,v'i-hES - <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and bekef,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization ovming the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign lo: tYt � . : ' :..Th 1iIq �is <br /> here Authorized Signature Title 6 Date <br /> FOR COUNTYTREASURER RECOMMENDATION <br /> APPROVAL RECEIVED COMMENTS: AL-S - ,400 <br /> st.vi% <br /> ❑DISAPPROVAL a eFt'ic4 fp <br /> A <br /> NOV 2 3 2015 ` SEAL �t1-/d-/.5" <br /> /Signature of County Treasurer Date <br /> HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASuRL.RS OPP1ee <br /> GRAND ISLAND,NEBRASKA <br /> [(APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> 'aorized 40. : •ate <br /> Nebraska Department of Revenue Authorized by Nob.Rev.Slat§§77-202(1)(c)end(d),and 60-30 85,and 80-3,189 <br /> 96-253-2008 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />