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A CIin gc-iLCA <br /> NERRAService. I Application for Exemption ( FORM <br /> Good Lie Great from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> c •Read be filed with your on county treasurer. zs <br /> •Read instructions on reverse Ownership <br /> L f <br /> Name of Organization <br /> HEARTLAND LUTHERAN HIGH SCHOOL Type of <br /> Nonpofship <br /> ®Nonprofit Corporation El Other(specify): <br /> Name of Owner of Property County Name <br /> State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address Contact Name <br /> 3900 W HUSKER HWY T Phone Number <br /> City illy �eee% C3U39 3d5 r9aa <br /> State Zip Code Email Address <br /> GRAND ISLAND NE 68803 pr;ne ?aiQrheer{londle eran.ciJ <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title c Address,City,State,Zip Code <br /> Ch ie} Sd,n S(reiec <br /> [Name, <br /> Tj2 2735 Oufknncycn 5i., ( tnd fsk.ri AE 69dc3 w,cvx o ec,rp eRcs pg,. ,s-\;e1 WrcVcc <br /> ; 537"fileroar;al Or., &,rend Iskrtir A.16 tae1'c�o/ <br /> Description of the Motor Vehicles <br /> •Attach an additional sheet,if necessary. <br /> Motor Vehicle Make Model Year Botl T Registration Date or <br /> Y YPO Vehicle ID Number Dale of Acquisition, <br /> �IM'.w,cS c{5 PC' C n�cY i3v �cOC 3 �. if Newly Purchased II <br /> �s i��7RaCd?3ll3re;y <br /> Chevy S.1bUfix,n lefici Si.M,:km 3Ge“citnnXGJiea% <br /> Exempt Uses of Motor Vehicle: <br /> Are the motor vehicles used exclusively <br /> Agricultural and Horticultural Society Educational ❑ as❑Charitable ❑Cemetery s indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: <br /> YES 0 N <br /> tiCh•cieS rare users ko srcnrxtp,c'{ Slick-AS Water ;.; cS <br /> If SKIS \t �S, 5« L. They Osc no; r)Sc Ct No,give percentage of exempt use:Te <br /> ir,;ci',ngs, ac Sc.Scr�;ce a outS�dc <br /> d,cec\ Schcdt tx i0C5S. <br />• <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> I also declare that I am duly authorized to sign this exemption application. <br /> sign / ( ( I / 1 <br /> here Zed Signature ` iv, S ripm;n,$ wtor toi'�-f? <br /> Title <br /> Date <br /> For County Treasurer Recommendation l <br /> ��� ,,� ,� Dpi ��p .�r��X 1 <br /> ypproval I <br /> • i s�jamment : &jL1 is l7c ! ,en Uvv <br /> ❑Disapproval j <br /> f DEC x02018 <br /> /Signe ure o f-C o u n t y Lea rer <br /> HALL COUNTY p Date <br /> TacA,StR`--S Gi41GC or Cou ty Board of Equalization Use Only <br /> GRAND ISLAND,NEBRASKA <br /> Approval Comments: <br />• <br /> ii ❑Disapproval _ / . <br /> Alligze L <br /> f (g i b. <br /> Auth• mad Signatu <br /> D <br /> Nebraska Department d Revenue <br /> 96braska 6Rev.12018 Supersedes 96-253-2006 Rev.82011 Authorized by Neb.Rev-Slat,§§77.202(1)(c)and(d),and 603,1&5,and 603.leg <br /> Please retain a copy for your records. <br />