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2010 <br /> t•►^---z_--- Application for Exemption FORM <br /> Nebraska DaPnlnent of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. i <br /> •Read inefrucd ens on reverse side. <br /> ARNicam's Naas --._"-_-._-----.�_.--'-_.�.-- —__ Type of Owrerstyp .._-._ <br /> ST PAULS LUTHERAN CHURCH bS'r"Nonprofit <br /> Street or Other Mailing Address County Corpomvon <br /> 1515 S HARRISON ST HALL <br /> 0 other-opowy): <br /> City - State Zip Code Slate Where Incorporated <br /> -� <br /> GRAND ISLAND NE 68803 NE j <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tide Name.Address.C' ,State,Zip Code _ <br /> kes���t i_0- I .1 /)J��IA.f. Trl iirl y �,�>�� f in !se-j <br /> e-� et 4/ '}� ill rc _ 1 .� Str...a yJ.t f,�.C_., . . 4 ^�r fO Lk \V_ it. Pik i. ,.rlL'P1 <br /> lft°liS4ie�C Cif_ .. <br /> 'rel- <br />. <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,If necessary. <br /> 1 1 Registration Data or <br /> - hjgfgSYen ..: r I ModelYear Body Type Vehicle ID Number --- Date of Acquisition, <br /> {1 492-1 � AS i i BNewbPUrehased <br /> i _ _ a°r 2 <br /> I <br /> I <br /> I 1 <br /> Exempt Uses of MotorYehicie: Are the motor vehicles used exdusivsy <br /> D Agdoult uattiorbcufural 0 Educational R ligious 0 Chadtalye 0 Cemetery as indicated? <br /> Give detailed description of use,indudmg an explanation if multiple use classifications exist: DYES ❑NO <br /> L.`VarG� J'recl5lCyP.i - \o.,`�'\ QCGt() e}r3\c,U.S C`e.LSSeS g No,give percentage of exempt use: <br /> Cl•% ;k∎Oeca.ce `'• �ces \ ,O` •S <br /> Under penalties of taw.r declare that 3 have examined this application and that it is to the best of my knowledge and belief,true,complete,and correct.I <br /> also decays 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 emptgyment based on r,of national origin. <br /> sign .' ... _1 / /dt 1�.Yf l <br /> here Author!. -tee Rue <br /> Uu <br /> L— –FOR COUNTYTREEASSUfREERR�REECC.OMMMENDAATIION <br /> 1 APPROVAL RECEIVEDc0MMEVTS: A 2 / /-- ry•S-5" "1*-77 49°,2J <br /> 0 DISAPPROVAL __.__. --- ___________ <br /> DEC 1 3 2017 c `, L ia a i7 <br /> It Signature of Coun Treasurer Date <br /> 1----'-'----'-'-'-_.-_L._ HALL COUNTY ppO�pp COUNTY BOARD OF EQUALIZATION USE ONLY—'-'------ ---'-'----- ----------'--------i <br /> GRAND ISLAND,NEBRASKA <br /> IPPROVAL COMMENTS: ., <br /> DISAPPROVAL <br /> elik <br /> signature Date <br /> Nebraska Depamnard of Revenue Auttrazed by Neb.Res.Slat.§§77-20211 KO arid(d).and so-s l85.and 663,189 <br /> 3635.}2006 Rat 8-2011 Supersedes ab-253.2006 Rev 0-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />