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N^.--z_- Application for Exemption
<br /> ,O/�
<br /> Nebraska Department M FORM
<br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457
<br /> •To be filed with your county treasurer.
<br /> -J •Read Instructions on reverse side.
<br /> Applicant's Name Type of Ownership
<br /> TRINITY LUTHERAN SCHOOL ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 208 W 13TH ST HALL
<br /> ❑Other(specify):
<br /> City State Zip Code State W here 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 /> .LL a✓a .Ate yh , •,a ._ - . 30/6 ii- . ., r.,. - : ci dr...dl_ , and £ , 8 .03
<br /> � lllTi• : /r rr •,t
<br /> rr ,ir. rll f ,Ir r Ia £ Sr .•a
<br /> Jo . 7/51w. l" st, u
<br /> fir ,,. . �/�`` _Ae.a,. ... a la.. 7
<br /> DESCRIPTION OFTHE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> Registration Date or
<br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number I Date of Acquisition,
<br /> If Newly Purchased
<br /> /Jlue6iret 7008 Bus ILiji0tn I BRk DCKrt_28F2.�JLSi
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> ❑Agricuburat'Honicultural 0-Educational •Religious ❑Charitable ❑Cemetery as indicated?
<br /> Give detailed description of use,including an explanation if multiple use classiicalions exist: U'`S ONO
<br /> If No,give percentage of exempt use:
<br /> .,i/74 sus - errs r7'Y y SC/100/S7udevr/s a-n d
<br /> chateh rrient4eC h) ael-ivrEies
<br /> Under penalties of law,I declare that I have examined this application and that d 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 /> TI-7 La- 5 .- f
<br /> Sign els_
<br /> kJe %, Aireieni.. m-1nerpsi I!— l(2 — c
<br /> here Authorized Signature Title Date
<br /> FOR COUNTY TREASURER RECOMMENDATION �c°
<br /> 3APPROVAL RECEIVED COMMENTS: At-0, ' .4)-41. ..F. .s"-.7_��...?
<br /> ❑DISAPPROVAL ��,.,,�� I SEAL
<br /> NOV 1b 2015 "�y� %c a , k., /7iG-ice
<br /> II.Signature of County Treasurer Date
<br /> I HALL COUNTY
<br /> TREASURERS ornor FOR COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> �J GRAND ISLAND,NEBRASKA
<br /> 5/APPROVAL APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL .
<br /> 1 tf
<br /> Lam, L //i ,d .617-07-10-24
<br /> •r prized Signature uate
<br /> Nebraska Department or Revenue Authcdzed by Neb.Rev.Stet§§n-202{1)(c)and(d),and 80-3,185,and 80-3,189
<br /> 96253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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