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File wifhYour Application for Exemption FORM <br /> County Treasurer from Motor Vehicle Taxes by Qualifying Organizations 457 <br /> •Read Instructions on reverse side. <br /> Name of Organization % Tax Year Value of Motor Vehicles <br /> Central Nebraska Lutheran School 2026 $20,550 , <br /> Name of Owner of Property County Name State Where Incorporated <br /> Hall 7 NE <br /> Street or Other Mailing Address / Contact Name Phone Number <br /> 212 W 12th Street Ruth Koch (308)382-0753 / <br /> City State Zip Code Email Address <br /> Grand Island NE / 68801 businessmanager@tIcgi.org i <br /> Type of Ownership: ,� <br /> ❑Agricultural and Horticultural Society 0Educational 0 Religious ❑ Charitable ❑ Cemetery 0For-profit Nursing Facilities <br /> Charitable Organizations:Motor Vehicle described above is used in the following exempt category(please mark the applicable boxes): ✓ <br /> 0 Agricultural and Horticultural Society Q Educational Religious ❑ Charitable ❑ Cemetery <br /> Charitable and For-Profit Organizations,please answer the following: if No,give percentage of exempt use: <br /> Are the motor vehicles used exclusively as indicated?(see instructions) ❑ YES 0 NO % <br /> For-profit Nursing/Assisting Living Facilities,please select the applicable box: What percentage, of occupied beds have been provided to <br /> ❑ Nursing Facility ❑Skilled Nursing Facility 0Assisted-Living Facility medicaid beneficiaries over the most recent three-year period? q• <br /> Name Titre of officers, Address,City,State,Zip Code <br /> Directors,or Partners <br /> Rachael Buck President 611 Linden Ave,Grand island,NE 68801 <br /> Blake Saltzgaber Vice President 222 Little Bluestem Dr S,Grand island,NE 68803 <br /> Josh Meyer Treasurer 1955 W Binfield Rd,Doniphan,NE 68832 <br /> Description of the Motor Vehicles <br /> .Attach an additional sheet,If necessary. �{ <br /> Dareo a ui�ittfe or <br /> Major Vehicle Make Model Year BodyTyibe Vehicle ID Number if Newly Purchaser <br /> Thomas Built Bus Co./46 passenger 2003 Bus 1T7YR2C2731131834 2/1/2026 <br /> Chevrolet 1999 SUBRB/CARRY ALL 3GNEC16R9XG210246 2/1/2026 <br /> Ford 2018 Van 1FBZX2CM4JKA68180 2/1/2026 <br /> Give a detailed description of the use of the motor vehicle: <br /> Used for transporting school students and employees for activities such as field trips, athletic events, <br /> and competitions, etc. <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 ei.- 66,-- <br /> 6 _ Business Manager 2/12/2026 <br /> here ,Authorinature Title Date <br /> IFor County Treasurer Recommendation <br /> RECEIVED EXEMPT PER NSS#77-202 <br /> Wpproval Com Tients: 2 <br /> Denial v R1.114u1t /Y <br /> F EB 1 2 2026 aid-; ali9,46V <br /> HALL COUNTY .Signature of County Treasurer Date <br /> TREASURERS OFFICE <br /> _ GRAND ISLAND,NEBRASKA For County Board of Equalization Use Only <br /> JP"Approved If the County Board`s determination Is different from the County Treasurer's recommendation,an explanation is required. <br /> 0 Denied <br /> I declare that to the my knowledge and belief,the determination made by the County Board <br /> of E on is co pu ant to laws of the State of Nebraska. CA <br /> c/ / <br /> v' c T- v <br /> gn ure of n and m Date <br /> Rev.7.2024 Authorized by Neb.Rev.Stat§§77-202(1)(c)and(d),and 60-3,185,and 80.3,189 <br /> Please retain a copy for your records. <br />