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Zotc <br /> NS Application for Exemption FORM <br /> Good LAe.Great Service. from Motor Vehicle Taxes by Qualifying Nonprofit Organizations <br /> E•.o, E a.•. •To be filed with your county treasurer. 457 <br /> I •Read instructions on reverse side. 'i <br /> Name of Organization Type of Ownership <br /> ST PAULS LUTHERAN CHURCH ®Nonprofit Corporation ❑Other(specify): <br /> Name of Owner of Property County Name State Where Incorporated <br /> HALL NE <br /> Street or Other Mailing Address <br /> g Cgnia`t Na^A A) Phone Nu er t//� <br /> 1515 S HARRISON ST G`Jf�(AVl ' ( — 2973 <br /> City State Zip Code Email Address , <br /> GRAND ISLAND NE 68803 m - IS 14' .rf�nl <br /> Identify Officers,Directors,or Partners of th Nonprofit Organization ation <br /> Title Name.Address,City,State,Zi•Code <br /> PriEWEWiriall•IIMIIIMMUMIUSealti'MMIIIIIZMANIIIIWATCH, ,, <br /> kinarivarzwinntoiramirmaaranft lll. 1W11 . item ry f.. rittlfille.�r��.f*�rN— �r lis <br /> i <br /> Description of the Motor Vehicles i <br /> •Attach an additional sheet,if necessary. 1 <br /> Registration Date or l <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> MAO i attire eIWardr /,31nan. 1 <br /> ] <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural and Horticultural Society ❑Educational it Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: YES ❑NO <br /> l/ �`ieeS l CJJ1VA9S — �-1i��ovs Licsces If No,give percentage of exempt use. <br /> t <br /> Under penalties of law,I declare that I ave examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. <br /> I also d.,ar-that I Kin duly thud a sign this exemption application. <br /> sign _ —'tp�`' <br /> here IAUthori ,lit re T Date <br /> ���4�� <br /> For County Treasurer Recommendation <br /> f ry� —1 <br /> Approval RECEIVE' ments LX� #f't per NC5*7?aka <br /> ❑Disapproval <br /> D E -^.(r 1 <br /> L c ,,,a ► g - .lu:y'�rtasu,rer la( 13j l8 <br /> Signature unt Treasurer Date <br /> I HALL COUNTY For Coun,y Board of Equalization Use Only <br /> TRE.-t3uRf_R3 CPFiCE <br /> GRAND ISLAND,NEBRASKA <br /> `•Approval Comments: <br /> ❑Disapproval -� <br /> X / / <br /> ,� /c}, /,!-s/� U <br /> Auth¢rized Si. ature Date / <br /> i <br /> Nebraska Department of Revenue <br /> 90-253-2006 Rev.T-2018 Supersedes 96-253-2006 Rev.82011 Authorized by Net.Rev.Stal.§§77.202(I I(c)and(d),and Ee-3.1e5,and 60-3.189 <br /> Please retain a copy for your records. <br />