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ao17 <br /> +, Application for Exemption 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 /> •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 ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Chairman o+ fcnvIaqrP ev cn Cnavy Scafanrt-i-3t�ilr?rwdwtcei Blvd Aras-Id triavtd AIE fo$�'D 1 <br /> ■icc autirmavi o-f (�cvsvecedien Nut Pic[aavdren-aal E Aflt*n tomes/ Island ME OM <br /> li?&h.VLY u 12.nimy gen-- 1,1 W 71hPet+ brand. lrlvnI NE tokr0I <br /> CNairman of Trur°Feet Lavru W;14nn- a35 e. Rri-poc-t 2d C-ra-nd !slava( n1E lo2703 <br /> J 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 Date of Acquisition, <br /> if Newly Purchased <br /> BLUEBIRD 2008 BUS 1BAKDCKH28F251252 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational u rY Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: VIES ❑NO <br /> AC.44V 14j Bus- -Warn pOrt?rlJ q SC hoe Sludcn+s F ehu.vch If No,give percentage of exempt use: <br /> mcwtb-evs -ft acf-ivif,td, T <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 z :es. _ . . $uIliJesS ylNAbet, Iiiifli+o <br /> here Authorized <br /> Signature Title Dal <br /> FOR COUNTY TREASURER RECOMMENDATION / 77 -7 <br /> APPROVAL COMMENTS: elf-nil/Cie �-� <br /> ❑DISAPPROVAL RECEIVED (p f �,j,/ <br /> '��/-7 / —/ �r <br /> NOV 2 8 201% )Signature of Cou tyTreasurer y-` Date <br /> FOR COU BOARD OF EOUAUZATION USE ONLY <br /> HALL TREASURERS OFF <br /> S ICOMMEN •: <br /> ❑APPROVAL GRAND ISLAND,NEBRASKA <br /> ❑DISAPPROVAL <br /> l� aif lei _ l 2a 711 <br /> thorized Sigma, rr Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§T7-202(1)(c)end(d).and 60.3,165.and 60-3.159 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />