Laserfiche WebLink
0, ! 7 <br /> in^_r__- 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 /> ST PAULS LUTHERAN CHURCH E Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1515 S HARRISON ST HALL ❑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 /> ' -cta-,'%Nes111- —Tarp l lame Mo7 .dow &1 z :550 . <br /> . re- W. - I' / I i sr; ,.. ►. A . _ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,If necessary. <br /> Registration Date or <br /> Motor Vehicle Make I Modal Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased _ <br /> TOYOTA 2007 SIENNA SPT VAN 5TD2K23C17S092102 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural ❑Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: ❑YES ❑NO <br /> . r ),q II ID‘...S f�iCJc�.� If No,give percentage of exempt use: <br /> CSC.. .1 % <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 /> 11 <br /> hea � E - ti <br /> Authorized Signature 1114; Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> ®APPROVAL y MMEN 5 7,-e_4.-, N,-,C, �� °,2 <br /> i RECEIVES <br /> El DISAPPROVAL! <br /> I <br /> 0-� ) 611 sae /-'.�-i7 cFC 2016 <br /> � <br /> Signature of County Treasurer Date <br /> FOR COUNT BOARD OF EQUALIZATION USE ONLY <br /> -rrn¢COuN l 1 <br /> TREASURERS OFFICE <br /> ❑APPROVAL GRAND ISLAND,NEB : <br /> ❑DISAPPROVAL . _ / <br /> ,,<�.� . Par c:e-- <br /> A -A /—/if/7 <br /> •,thorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60.3,185,and 603,169 <br /> 96-253.2006 Rev.8.2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />