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490 / 7 <br /> Nebraska�+ o Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> *To be Med with your county treasurer. 457 <br /> •Read Instruodone on reverse side. <br /> Applkanes Name Type of Ownership <br /> TRINITY LUTHERAN CHURCH cm Nonproa <br /> Street or Other Melling Address Coimy - - Corporation <br /> 212 W 12TH ST HALL ❑other(specify): <br /> City Stale Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,Oily,Slab,Zip Code J �,r <br /> ../Ai 14t 4 ti en r i 949 +I Se.ere.I ' S 7I. ME, it q At, td /slaw" re <br /> i r 1 49 LIr *4111f §J . t l .1 . a1 (' i ^ C_4 4 • a Me- 4 . D <br /> —Re afllvev —atom trrvs— IN IN, lilt S-1n?4 Evan fs1an, IJ6 bi10I <br /> L!i LL.A 1e A . ex — - a /f t Lt,. 1 L. tan' • lc. 4�! <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach en additional sheet,If necessary. <br /> Regisirallon Date or . . <br /> Motor Vehicle Make Model Veer aody Type Vehicle ID Number Dteof Acquisition, <br /> FORD 2010 CUTAWAY VAN E450 1FDFE4FS7ADA74436 <br /> DODGE 1995 RAM WAGON 2B5WB35Z8SK61600 <br /> d6Rft _. .... . . - <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agd utturay}brticullural 'Educational EThellglous ❑Charitable ❑Cemetery as§Idlcated7 <br /> Give detailed description of use.Including an explanallon If multiple use classifications exist liel<ES ❑NO <br /> used ' rr-fretriSpcHi19 Gh.w'tk and ui-toot P) tk bCU if No,give percentage of axes"!use: <br /> -Iv r- acfivitiPS. % <br /> Under penalties of law.I declare that I havve examined Iola appecatbn and that II le,to the best of my knowledge and belief,true,compete,and correct I <br /> also declare that I am duly authorized to sign this exemption application,and that the oryenlzallon swung me above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign J/ l .� ' I . .' �J-4 Balm-QSr N{ ,c,Y 11 r <br /> here Aul . edSiymlure Tale Date <br /> FOR COUNTY TREASURER RECOMMENDATION �I <br /> O/ C S 7't �—� <br /> .� <br /> PROVAL _R CEI l r� M ' �" ,RE -� / ��j <br /> ❑DISAPPROVAL <br /> NOV 2 8 2016 Signature a Treasurer Date <br /> I FOR COUNTI'BOARD OF Ell UAUZATION USE ONLY <br /> HALL COUNTY OO������ <br /> TREASURERS <br /> ❑APPROVAL GRAND ISLAND,NEBRAdlNMENTS: <br /> ❑DISAPPROVAL ' <br /> . <br /> • <br /> . 'se• 1•rir � Date - <br /> Nebraska Department of Revenue AuSMdred by Neb.Ray.Sled§§77-202(1J(c)o 1d ca and 60-3,185.end 803,189 <br /> 9825 3-2006 Ray.B-2013 Supersedes 963512005 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />