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gOtg <br /> isavn----e....- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To he filed with your county treasurer. <br /> _.—'_ants—_.--.—.--_—__—__ <br /> •Read instructions on reverse side. <br /> ._—__.-__._.. <br /> Ap EAR Name ^^ ^ Type of Ow refit p <br /> HEARTLAND LUTHERAN HIGH SCHOOL �—3 Jy C•�,L—iy �; Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 3900 W HUSKER HWY HALL <br /> City --------&de Zip Code --- State Where incorporated--� Other(specify): <br /> GRAND ISLAND NE 68803 NE ____________ <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title I Name Add:ass.City,State,Zip Code <br /> Ca <br /> res�_.-1 541r-1 4541 - c =5 l_ =. 1_Ar_C _ 4___— <br /> I <br /> DESCRIPTION OFTNE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> I I ! Registration Date or <br /> Motor Vehicle Make I Model Year i Body Type ! Vehicle ID Number Date of Acquisition, <br /> int_ _ h _ ._. �_ .tint_ a ..j.._. I • l if Newi(yPUrchased <br /> nt ...._._.'I.JS sS 11 --A" I <br /> ! ; <br /> I ! . <br /> I <br /> — -- -- . <br /> Exempt Uses of Moto•vel*le: __— i Are the motor vehicles wise exclusively <br /> [ AgriculkuaVHonigdtural �ducstlonai `0 Religious U Charitable 0 Cemetery 3 its indicated? <br /> I <br /> i <br /> Dive detailed description of use,including an explanation if maniple use classifications exist: � XES ^NO <br /> Used -Qv- `lion -h �-i-udcnis t 4- <br /> r��c� 1 n N0.$va percentage of axerripi use: <br /> 3 ctaded c-hvl�i 4?Y vs r< <br /> acnis,ies rea act, i c of e4i& s <br /> Under penalties of taw,I declare that I have examined this application and that it le,to the best of my knowledge and belief,true.complete,and correct I <br /> also dears that I am duly authorized to sign this exemption application.and that the organization owning the above-listed property does not discrkninate <br /> to me „ -h`p or employment based on race,color,or national origin. <br /> sign �1D. iJii1Z • MVancen'!eni-44tricu1C( 11-(-)7 <br /> Jere Auto >.Signature Title j Date <br /> I_,.,.—�— ---_ FOR COUNTYTREASURERRECOMMENDATION <br /> +APPROVAL ----------- rnL4MFNI'$: .SS '9` 77-a2 -- <br /> DISAPPROVAL RECEIVED.-----------------------� �-------)---- --- ----------------------- --------- <br /> NOV 9 2017 rrSignatudo myR Date <br /> _.------_-_------__-_--FOR COUNTY BOARD OF EQUALIZATION USE ONLY J <br /> HALL COUNTY <br /> APPROVAL TREASURERS OFF ereN IT; <br /> GRAND ISLAND,NEB <br /> J DISAPPROVAL <br /> — <br /> r i� d .nature Data <br /> Netvexxa otestr nt C tbwaa;e Authorized by Nei Ras Slat M/T-202(T(o)and(d),and e0-31as.and e0s.189 <br /> 96.2532006 nor.&201 I Supersedes at-258.2006 Rev 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />