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File with Your Application for Exemption FORM County Treasurer from Motor Vehicle Taxes by Qualifying Organizations 457 •Read Instructions on reverse aide. Name of Organization Tax Year Value of Motor Vehicles Central Nebraska Lutheran School 2026 $72,000 Name of Owner of Property County Name State Where Incorporated Hall NE Street or Other Mailing Address Contact Name Phone Number 212 W 12th St Ruth Koch (308)382-0753 City State Zlp Code Email Address Grand Island NE 68801 businessmanager@ticgi.org Type of Ownership: ❑Agricultural and Horticultural Society 0 Educational ✓❑ Religious 0 Charitable ❑ Cemetery ❑ For-profit Nursing Facilities Charitable Organizations:Motor Vehicle described above Is used In the following exempt category(please mark the applicable boxes): ❑Agricultural and Horticultural Society 0 Educational ✓❑ Religious ❑ Charitable ❑ Cemetery Charitable and For-Profit Organizations,please answer the following: If No,give percentage of exempt use: Are the motor vehicles used exclusively as Indicated?(see Instructions) [AYES ❑ NO % For-profit Nursing/Assisting Living Facilities,please select the applicable box: What percentsgge of occupied beds have been provided to 0 Nursing Facility ❑Skoled Nursing Faculty ❑Assisted-Living Facility medicaid beneffciarles over the most recent three-year period? % Name Tie Officers, Address,City,State,Zip Code Directors,or Partners • Rachael Buck President 611 Linden Ave,Grand Island,NE 68801 Lisa Manchester Vice President 3820 Hampton Rd,Grand Island,NE 68803 Josh Meyer Treasurer 1955 W Binfield Rd,Doniphan,NE 68832 Description of the Motor Vehicles •Attach an additional sheet,if necessary. tration Date Motor Vehicle Make Model Year 9odyType Vehicle ID Number Re NB isWIy P chased Chevrolet 2017 VAN 1GAWGEFG9H1267787 4/27/2026 Chevrolet 2014 BUS 1GB3G3BG4E1146685 4/27/2026 Give a detailed description of the use of the motor vehicle: Used for transporting school students and employees for activities such as field trips, athletic events and competitions, etc. 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. 1 also declare that I am duly authorized to sign this exemption application. sign S -mac ,---i Business Manager 5/15/2026 here I Authorized Sill ature Title Date i �� . For County Treasurer Recommendation RECEIVED EXEMPT PER NSS#77-202 pappro+al Comments: ❑Denia, MAY 1 5 2025 ' fGGt' 4Pj2d&� 'TREASURERS C d OFF Signature of County Treasurer Date GrtAND rSLAN0,Nttmaar A For County Board of Equalization Use Only ✓✓✓ Approved If the County Board's determination is different from the County Treasurer's recommendation,an explanation is required. ❑ Denied I deuallz clare ais t tco othe best of know go and belief,the determination made by the County Board of Eq n rrect nt to awe of the State of Nebraska. Signs re of Coun 13 rd Member 0 to Rev.7-2024 Authorized by Neb.Rev.Stat.§§77-202(1)(o)and(d),and 80-3,185,and 60-3,169 Please retain a copy for your records.