Type of Ownership BUS REVENUE FORM PICK-UPlancaster.ne.gov/clerk/agenda/2018/180508/mv.pdf · Julte Spader, 14880 Old Cheney Road, Walton, NE 68461 DESCRIPTION OF THE MOTOR VEHICLES

^%rom:Cathedral of the Risen Christ 402 488 7895 04/17/2018 12:24 #328 P.001/001

^S - -W/~ ^-yfS^

sgayNebraska Department of

REVENUEiU!i>iaa:i»wiw.ia.tnniai'r

Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations

•To be filed with your county treasurer.• Read instructions on reverse side.

Applicants Name

Cathedral of the Risen ChristStreet or Other Mailing Address

3500 Sheridan BlvdCity State Zip Code

Lincoln NE 68506

County

LancasterState Where Incorporated

NE

FORM

457Type of Ownership

[g NonprofKCorporation

II Other (specify):

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OFTHE NONPROFIT ORGANIZATIONTitle

P: Bishop James Conley

VP: Msgr. Timothy ThorbumS/T: Msgr. Joseph J Nemec

Name, Address, City. Stale, Zip Code

3400 Sheridan Blvd Lincoln, NE 68506



DESCRIPTION OFTHE MOTOR VEHICLES•Attach an additional sheet, if necessary.

Motor Vehicle Make

INTLFORD

Model Year

19922000

Body Type

BUSPICK-UP

Vehicle ID Number

1HVBBNMP8NH4108771FTZR15V8YPA81498

Exempt Uses of Motor Vehicle:

II Agricullural/Horticullural II Educational |X] Religious It Charitable II Cemetery

Give detailed description ol use. including an explanation if multiple use classifications exisl:

Bus: Transportation of pre-school and school students and church membersPick-Up: Maintenance work for the facility

Registration Date orDale of Acquisition,if Newly Purchased

Are the motor vehicles used exclusivelyas Indicated?

^ YES Q NO

If No, give percentage of exempt use:

.%

Under penalties of law, I declare (hat I have examined Ihis application and thai il is, to the best ot my knowledge and belief, true, complele, and correct. Ialso declare thai I am duly authorized io sign this exemption application, and that the organization owning the above-llsled property does not discriminatein membership or employment based on race, color, or national origin.

^-,^.,0^ Hr 7^sign.h©rG ^ Authorized Signûre ^

•^t^^ Rector 4/16/18Title Dale

FOR COUNTY TREASURER RECOMMENDATION

'APPROVAL

D DISAPPROVAL

COMMENTS:

ire ol Uounly ireasurer

FOR COUNTC BOARD OF EQUALIZATION USE ONLY^

D APPROVAL

d DISAPPROVAL

COMMENTS:

Authorized Signature Date

Nebraska Department o1 Revenue96-253-2006 Rsv. 8-2011 Supersedes 96-Z53-S006 Rev. 5-Z009

Aulhorized by Neb. Rev. Slai. §§ 77-202(1)|c) and (d), end 60-3,185. and 60.3,189

PLEASE RETAIN A COPY FOR YOUR RECORDS.

Received Time Apr, 17, 2018 12; No, 4303

Nebraska Department of

REVENUErjiniaanfil.tna.l.-iaian^


•To be lllad with your county treasurer.• Read Instructions on reverse slda,

Applicant's Name

Christian Heritage Children's HomesStreet or Other Mailing Address

14880 Old Cheney RoadCity Stale Zip Code

Walton NE 68461

County


Nebraska

FORM

457Typs ol Ownership

13 NonprofitCorporation

[_] Olher (spadfy):

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OFTHE NONPROFIT ORGANIZATIONTitle

President

Vice PresidentSecretary/Treasurer

Name, Address, City, State, Zip Code

Brad Brown, 14880 Old Cheney Road, Walton, NE 68461

Brian Rader, 14880 Old Cheney Road, NE 68461Julte Spader, 14880 Old Cheney Road, Walton, NE 68461

DESCRIPTION OF THE MOTOR VEHICLES•Attach an additional sheet, If necessary.

Motor Vahlcte Make

HON DA Accord

ModelYear

2015

Body Type

D< (CVT) 4 door sedan

Vehicle ID Number

1HGCR2F3XFA125124

exempt Uses of Motor Vehicle:

Q AgrIcultural/Honicultural [~| Educational |3 Religious D Charitable D Cemelsry

Give detailed descrlpllon of use, Including an gxplanatlon If multiple use classlllcatlons exist;

Christian Heritage staff will use for appointments with foster families, pastors, donors andother transportation uses related to our exempt function to care for youth placed with us byNebraska DHHS.

Are the motoras Indicated?

EX^YES

If No, glvs peri

.°,

Registration Date orDate of Acquisition,If Newly Purchased

^\^1j

ehlcles used exclusively

D NO

sntage of exempt use;

Under penalties of law, I declare that I have examined this application and that 11 Is, to the best of my knowledge and belief, true, complete, and correct. Ialso declare that I am duly authorized to sign this exemption application, and Ihal the organization owning tha above-listed proparty does not discriminateIn mambershlp or employmsnt based on race, color, or national origin.

sign, AcirAn^ Secretary/Treasurer 04-25-2018Title Date


FAPPROVAL

d DISAPPROVAL

COMMENTS:

4^^z.1 Date

FOR COUNTY BOARD OF EQUALIZATION USE ONLY ^C]APPROVAL

H] DISAPPROVAL

COMMENTS:


Nebraska Department of Revenue66-253-2006 Rev. 8-2011 Supsrsedes 96-253-2006 Rev. 5.2009

Authorized by Neb. Rev.Slat. §§ 77.202(1)(c) and (d), and 60-3,185, and 60-3,189


N«bra»k» Department of

REVENUE>a.riu«iu-»,m«rn^*rir


•To ba (Usd wlffi yourcounly UMWfer., '.PSAd l"f."ctlona°" revere98ldB.

FORM

457Applicant's Nama

^.ov^murn+-'/ ^.60^.._ ^cw\^ / ^BRIdrasBStiael or Olhar Mailing At

loo N ^ ?rCily

-LLa-coAv^

Slflla

M<<Zip Cads

^w

County

U-AW^rStale Where Incorporated

^ ebr0t$ko\

Typa of Owiarahlp

ES NcnproIHOorpo ration

D OUw (spBClfy)!

IDENTIFY OFFICERS, OlRECTORS, OR PARTNERS OFTHE NONPROFIT ORGANIZATIONTina Name, Address, Clly, Stato, Zip Cods

Pce'nAevA' £.llev\ Ai<;oA\/o loo N W\\- <,T L^f;^, N^ fcÔ^

DESCRIPTION OFTHE MOTOR VEHICLES•Attach an additional sheet, If necossary.

Motor Vehicle MaKe

^ Set tttia-.Â -ÔVVA

Model Yaer Body Type Vehicle ID Number

ixsmpi uses of MoiorVehlcls;D Aflrioullural/Horlkiullure) D Educational D Religious |2) ChariiaMs D CBinBigry

Give detailed descilpllon of UBB, Including an BXplanatton 1( multiple use classlllcaltons exist;

M VeV:cU$ol<e Vc.cA -ôr ê pv^po^ 0^ Co^kÂP) w^dilivpry o1? bôoA,

Daia of Acquisition,JI-NewtfPurohMoif

Arelhe motor vehlolss UBfld exoluslrelyIwindfcatBdT

gives Q NO

If No, Slw pBreenlage of wempt use:

.%

Undsrpamlttes of law, I declare that I haw examine (t this dppllcallon and lliat II Ie, to?e best of my knowledge and bellal, true, complBle.anidmrrmU"alsodeolare Ihat I am duly auihorized to sign ihls sxempilon appllcailon, and that (ha organization owning ihe abova.llslsd proportydow noldlscriminnlBIn membsraWp or employmsnt based on rew, colofi or national origin,

sign,Aulhoilzad einnaluw

1r:\e^ _Cwf^^r t-l/'so/i^Titla -- Dat.

FOR COUNTY TREASURER RECOMMENOATION

I APPROVAL

D DISAPPROVAL

COMMENTS;

^^/<fFOR COUNTY BOARD OF EQUALIZATION USE ONLY

d APPROVAL

D DISAPPROVAL

COMMENTS;

^ Auihorleed Signature Data

Aulhariiaii b/ Neb, Rev. Slal, §g 77-202(1)(o) and (<))i and 60-3,185, and 6B.3,18SNobiciht DBpailnwhlolnavsnaeBO.asa-aooe'Rsr. 8-20118up8n»<)e» 9&-2S3-avw Rm 8'aooo


W Nebraska'^ Community Blood Bank

A Division of Innovative Blood Resources

100 N. 84th Street I Lincoln, NE 68505 | NCBB.ORG | 1-877-486-9414

April 20th, 2018

Vehicle List

Vehicle MakeBlue Bird Coach

Ford StarcraftFord F550Ford E350Ford TransitThomas

Thomas

Subaru Forrester

Subaru Forrester

Subaru Forrester

Dodge Gr Caravan

Model Year19992004201520062017200920172017201020112010

Body TypeMotorcoach

Motorcoach

Cargo Van

Passenger Van

Passenger Van

Motorcoach

Motorcoach

suvsuvsuvCargo Van

VIN #1BDJKCS7XXF0812781FDXE45P44HA787171FDUF5GY9FEA234371FBSS31L76DA194851FBAX2CM7HKB256421T8UYOB21911118825POUYAD20H1117620JF2SJAEC1HH583071JF2SH6BC1AH784026JF2SHBBC1BH7357742D4RN4DE4AR478101

Reg Date5/185/185/185/185/185/185/185/185/185/185/18

For Tax Exempt consideration.

84th and 0 Street | 16th and Pine Lake Road | 26th and Kensington


REVENUEnfiriaiiw-'s'si"--"™"


•To be died with your county treasurer,• Read Instructions on reverse aide.

Applicant's Name

Family Service Association of LincolnSlreet or Other Mailing Address

501 S. 7th StreetCtly State Zip Code

Lincoln NE 68508-2920

County

LancasterSlate Where Incorporatad

Nebraska

FORM


g] NonprodlCorporation

D Other (specify);

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OFTHE NONPROFIT ORGANIZATIONTills

President

Presldent-ElsctSecretary / Treasurer


Diana Schilf 1248 0 St., Ste 550, Lincoln, NE 68508

Steve Cass 2837 Brummond Dr., Lincoln, NE 68516Becky Shupe 3400 Plantation Dr., Lincoln, NE 68616

DESCRIPTION OF THE MOTOR VEHICLES•Attach an additional sheet, If necessary,

Motor Vehicle Make

FORDFORDFORD

Model Year

200820082008

Body Type

WSDWSDWSD

Vehicle ID Number

1FBSS31L88DA863731FBSS31L08DB222821FBSS31LX8DB19938

Exempt Uses of Motor Vehicle;

D Agricultural/Hordcullural K] Eduoallonal D Religious 13 Charitable D Cemetery

Give dalalled description o( use, Including an explanation If multiple usa classifications exist;

Advocacy and human service agency


200820082008

Are the motor vehicles used exclusivelyas Indicated?

^] YES Q NO


.%

Under penalltos or law, I declare thai I have examined this application and that It Is, to the best of my knowledge and belief, true, complete, and correct, Ialso declare that I am duly authorized to sign this exemption application, and that the organization owning the above-llsted property does not discriminatein membershlp^r emplpymeiil baggd on race, gylor, or nallonal^lgln.

signhere P-ûTh(ê<^nature

Director of Business & Finance 4/17/18Title Date

FOR COd^nÊASURER RECOMMENDATION

FAPIFAPPROVAL

D DISAPPROVAL

COMMENTS;

Signature of fcounly Trj6asufer^

^jrrfDate

FOR COUNTY BOARD OF EQUALISATION USE ONLY

D APPROVAL

Q DISAPPROVAL

COMMENTS:

Authorized Signature Dale.

Authorized by Neb. Rev. Stal. §§ 77-202(l)(c) and (d), and 60-3,186, and 60-3,189

PLEASE RETAIN A COPY FOR YOUR RECORDS,

Nebraska Department of Revenus86-263-2006 Rev. 8-2011 Supersedes 96-253-2006 Rev, 6-2009

"I/Nr-br^.'i^n Dftpnrtmrint Qf

REVENUEra:;>ra:i-.w».™».-Hi.<!ii


•To be filed with your county treasurer.• Read Instructions on reverse side.

Applicant's Name

FIRST SLAVIC BAPTIST CHURCHStreet or Other Mailing Address

3801LASALLE STREETCity Slale Zip Code

LINCOLN NE 68516

County

LANCASTERState Where Incorporated

FORM


II NonprofitCorporation

[_] Olher (specify):

— IDENTIFY OFFICERS, DIRECTORS, OR PARTN'ERS'OFfHENONPROFIT ORGANIZATION

Tille

TREASURERName, Address, City, Slate, Zip Code

VLADIMIR GATCHENKO134 34 JAMESTOWN ST.

WAVERLY, NE 68462

DESCRIPTION OFTHE MOTOR VEHICLES•Attach an additional sheet, If necessary.

Motor Vehicle Make

CHEVY EX2

FORD TRANSIT T-350

Model Year

20012015

Body Type

SPORT VAN

Vehicle ID Number

1GAGG25R1111308691FBZX2YM5FKA72366

exempt Uses of Motor Vehicle:

j_j AgricultufatiHofticultural || Educational R] Religious || Charitab'e || Cemelcp/

Giva detaif&d description of use, inciuding an explanation tf muttipte use class^ftcations exist:

TRIPS.GENERAL CHURCH USE

Registration Date orDate of Acquisition,if Newly Purchased

/\ - . '~1.

\cm ûio

Âre the motor vehic'es used exdusivelyas indicated?

^ YES Q NO

If No. give percentage ol exempt use:

."»

Under penalties of law. I declare thai I have examined this application and that it is, to the besl of my knowledge and belief, true, complele, and correct. Ialso declare Ihgl I am duly authorized to sign this exemption applicalion, and Ihat the organizalion cnvnlng the abo'/e-lisied propsrty does not discriminatein membership or emp'oymenl based on race, color, or national origin.

si9n .^^-^?.hQfQ Âuthorized Signature

Tê^^-e^Title

r2^^ô^?Date


'APPROVAL

Q DISAPPROVAL

COMMENTS:

FOR COUNTY BOARD OF EQUALIZATION USE ONL

APPROVAL

D DISAPPROVAL

COMMENTS:

Aulhorizecl Signature Date

^vtw^ D$p5.]-{FTt$ri! of Rev?r>u6"6-E53-20W Ri».'. 8.2011 Supersedes 96.253-2006 Re-;. 5-8r>03

Authorized by Neb. Rev. Slal. % 77-202|1 )(c) and (d), and 60-3.185, and tO.3.189


Nebraska Oepartmunt oi

REVSNUE5£Pl3dsd'S'ift%!:I'.-yLTj'f3!l'd


•To be filed with your county treasurer,• Read Instructions on reverse side,

FORM

457Applicant's Name

SMherMalli

•0<^fStreet or Other Mailing Address

Zfc^t" ^ ^/r^-Cily

-t^\<'0(<

State

<-1^£"

Zip Code

^Yo

County

C<*^.€^

State W.herg Incorporatedirg I

Type of Ownership

0 NonprofitCorporallon

D Other (specify):

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OF THE NONPROFIT ORGANIZATION

Tille

!âL//> ffîAjLî-?/»Jl <^_ /->(^^(J-«*V/-

i^tirJ ftcîLv^^.x^'-Ai/f- ^(Â/


't^MLy^ 3m ^r^ hfi^. C^'/- ^&(a??o^\r^ f-^k^ i ^Stfq\rMtr^£>r. ^^cet^ /J5 CK<&'L-'^n^[t'^^,^\ <JÂ^ ^^ ^r/^ f.'i^»f^J^^$/^l^.e^ '^^L^L> fYo? ^Â^'- L(/tCo^"'JL^^l^^

DESCRIPTION OFTHE MOTOR VEHICLES•Attach an additional sheet, if necessary.

Motor Vehicle Make

_^<>rc>

Model Year

^T.3

Body Type

-Cî^.

Vehicle ID Number

^QS52Q L- Wfi S>^«?/_

Registration Date orDale of Acquisition,If Newly Purchased

^/v-

^-


I] Agricullural'Horlicultural (^l Educational II Religious || Charitable |] Cemetery

Give detailed description of use, including an explanation if multiple use classilications exist;

Ve-k>Jo- \S u$e^ -hs 4rc^^?o/7/yo^ ^ CLAok ^•^ ^'^'^'^

^ f. ^}\ ^^ -^ i^ ^ ^/ r^ -^{ ^^^€"

^S^sr^ ^:^^^Si^l^ ^^- 1^ ^^<y rrV^r f^^ ^ /-u-n 1^ (to^fo.^

(aminei

Are the motor vehicles used exclusivelyas indicated?

jg YES Q NO


.%

Under penalties of law, I declare Ihat I have examirted thTS applicatlon'and thai it is, loIhe best of my knowledge and belief, Irus, complete, an<icorreci.Talso declare thai I am duly aulhorized to sign this exemption applicalion, and that Ihe organization owning Die abo'/e-listed properly does nol discriminalein membership or empfoyment based on race, color, or national origin.

sign,Authorized Signalure

^-^coM\s^ P't^/ t//U,TiUe— ~ ---- Dale"


APPROVAL

D DISAPPROVAL

COMMENTS:

^-/rDate

FOR COUNTY BOARD OF EQUALIZATION USE ONLY

Q APPROVAL

Q DISAPPROVAL

COMMENTS:


Nebraska Department of Revenue96-253.2006 Rev. 8.2011 Supersedes 96-253-2006 Rev. 5-2009

Authorized byNob. Rov. Stat. §§ 77.202(1 )(c) snd (d), and 60-3,185, and 60-3,189


3-31-2005 15:19 From:

Nabroo^ri Ot^ftnmani of

REVENUEia:].ia»l>»'«,BW3:l--l,-.igfr

To:4024416484

Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organi2ations

•To be llled with your county Ireasuror.• Read Instructions on reverse aide,

Pase:l^l

FORM

457Applicant^ Nameani^

Zff-ry^r CicH^rQy\ C^LtcrcL-Streol or Other Mailing Address

s~fo r. ^3 F<< 56.Cily

^/h coinSlala

/u5Zip Code

^_&57^_

County

L<snc^j-h:Y'$lale Whara Incorpoiated

Type ol Ownarehip

Q NonprolilCorporation

'^3'Olhar (spacify):

CJhJLLrr^

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OF THE NONPROFIT ORGANIZATIONTills

[^^rê^Name. Address, Clly, Slate, Zip Code

^-e^ôL^ ^soi ^..^\^1L^^^ t^^tcr^^&or^ / ft^ll CÔS AJ. ^^> •J l-.v^t^ AJfi-

^5-^^Tr€QSU_rf.r- ^.%5-

DESCRIPTION OF THE MOTOR VEHICLES•Attach an additional sheet. If necessary.

Motor Vehicle Make

IncdL

Model Year

<?aa3

Body Type

vacv

Vehicle ID NumberRcglstrallon Dale orData ol Acquisition,It Newly Purchased

IFOSS-SLL.^HS^.^ -^//i-


D Agrlcuttural/HorticuIlural Q Educational ^3 Religious D CharHabla

Qlve dalailed doscriptlon of usa, inelUCllng an explanalton 1< mulllple UGS classlllcatlons exisl;

Th'l^Spwt \^cc<^ 4o <?v<?^S.

T>e>r^sp^'t YY^> wJ&yrS ~^« ^Âc/rcA-

|_1 Cemetery

A!'Q Iha motor

as iiWicaied?

^YES

If No, ftlve pan]

Kliielea used exclusively

D NO

;onl?ge ol exempt use;

Undftr penallieB of low, I dedara thai I have examined this applicadon and thai ll is, to Ihêal o( my knowledgB and^ bcllel' uue. comploalso dBcla'ethai I am duly (lumorized lo Sign ffils exemption oppllcation, and that tha organiMtlon owning Iho above-lislad prapariy do9EIn mBmbership w employmsnl bosad on raco, color, or national Oilgln.

i, and correct. Ii0l dlacfiminalo

sign C.^^ £ÛL.PhGr6 Aulhoifaod Signature 7

__ ^^r.^Jl S^Cr^-^Q^^ ^!_~JZL=i§>Title - f DS'a

FOR COUNTYTREASURER RECOMMENDATION

APPROVAL

Q DISAPPROVAL

COMMENTS:

>

n-

SignaluW Ql CcWnty Trâuier

r<^16 "/Diila

FOf^COUNP/ BOARD OF EQUALIZATION USE QNL^

D APPROVAL

Q DISAPPROVAL

COMMENTS:

Autliorlzed Signature Dale

NobroiriTOSpsrlmBnl 01 HsvnnuAB6-253.200«R8v,fl.20n Supersedes 66-253-zoofl Rev, 5-zoOS

Aulhorlzed by Neb. Per. Siai. 66 7?.2u2(1)(({| and Wi.pnd IiU-3,185, and 00-3.1BO

PLEASE RETAIN A COPY FOR YOUR REGORDS-

Received Time Apr, 17, 2018 1:40PM No, 4340


REVENUEia:nia3:ir».i;Ki»-i.-n]a.-r


•To be filed with your county treasurer.• Read instructions on reverse side.

Applicant's Name

St Monica's HomeSlreet or Other Mailing Address

120 Wedgewood DriveCity Stale Zip Code

Lincoln NE 685140-2431

County

LancasterStale Where Incorporated

Nebraska

FORM


^ NonprofitCorporation

Q Olher(spncify):

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OF THE NONPROFIT ORGANIZATION

Title

Executive Director

Board President

Director of Operations

Director of Finance

Name. Address, City, State, Zip Cods

Mary Barry-Magsamen, 120 Wedgewood Drive, Lincoln, NE 68510-2431

Bobby Truhe, 120 Wedgewood Drive, Lincoln, NE 68510-2431

Gail Javorsky, 120 Wedgewood Drive, Lincoln, NE 68510-2431

Tammy Hayes, 120 Wedgewood Drive, Lincoln, NE 68510-2431

DESCRIPTION OF THE MOTOR VEHICLES•Attach an additional sheet, if necessary.

Motor Vehicle Make

Ford

Model Year

2017

Body Type

Van

Vehicle ID Number

1FBZX2YM4HKA57621


[_] Agricullural/Horlicullural [_\ Educational Q Religious [3 Charitable Q Cemetery

Give detailed description of use, including an explanation it multiple use classifications exist:

Vehicles are used to transport clients in residential substance abuse treatment programs toand from living locations to treatment, meetings, and appointments.

Registration Date orDate at Acquisition,if Newly Purchased

4/20/2018


^ YES Q NO

If No, give percentage of exempt use;

-%

Under penalties of law. I declare thai I have examined this application and that it Is, to the best of my knowledge and belief, true, complete, and correct. Iaiso declare that I am duly auihorized to sign this exemplion application, and that the organization owning Ihe above-listed properly does not discriminatein me;nbership or empjoymenl based on race.ôlor, or.-national origin.

si9", ^-^W/W^^M.^-Âulhonzed .Signature

Director of Finance 4/23/2018

'..'•' <-"7Z: Tille Dale


APPROVAL

D DISAPPROVAL

COMMENTS:

Signature of Coun|y Treasure


^ i^\ SDale

Q APPROVAL

D DISAPPROVAL

COMMENTS: ___


Nebraska Depfirtment of Revenue96-253.3006 Rev 8-2011 Supersadas 86.253-2006 Rev 5-2009

Authorized by Neb Rev Stal. §§77.202(1)(<:| and (d), and 60.3,18s. and 60-3.183



REVENUElaii'im.trr-w*"''""'


•To be tiled with your county treasurer.• Read Instructions on reverse side.

FORM

457Applicant's Name

St. Teresa ChurchStreet or Other Mailing Address

735 So. 36th St,City

LincolnState

NEZip Code

68510

County


Nebraska

Type of Ownership

g) NonprofllCorporation

[_] Other (specify):

IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OF THE NONPROFIT ORGANIZATIONTitle Nama, Address, City, State, Zip Code

President James Conley 3400 Sheridan Blvd,, Lincoln, NE 68506

Vice-president Timothy J. Thorbum 3400 Sheridan Blvd., Lincoln, NE 68506

Secretary-Treasurer Jamie S. Hottovy 735 So. 36th St., Lincoln, NE 68510

Trustees Daniel Wesotowski 3901 J St., Lincoln, NE 68510 and Stacy Rickel 870 So. 36th St., Lincoln, NE 68510

DESCRIPTION OF THE MOTOR VEHICLES•Attach an additional sheet. If necessary.

Motor Vehicle Make

Oidsmobile Ciera S

International

Model Year

19962003

Body Type

4 Door Sedan

School Bus

Vehicle ID Number

1G3AJ55M5T63771444DRBRABMX3B950858

Exampt Uses of Motor Vehicle:

[_] Agrlcultural/HorlicuHural [3 Educational [Xl Religious [__] Charitable II Cemetery

Qiva detailed description of usa, including an explanation if multiple use classifications exisl:

Ciera - Transportation for religious and educational purposes, school related functions andadministrative duties.

International - Transporting children to and from school activities. Also, to transport membersof St. Teresa Parish to religious and parish events,


5-22-06

7/2006


^ YES D NO

If No, give psrcentage of exempt use:

.%

Under penalties of law, I declare that I have sxsmined this application and that it is, to tha best of my knowledge and belief, Irus, completa, and correct. Ialso declare thai I am duly authorized to sign Ihls exemption application, and that thg organization owning the above-lisled property does not discriminat?in membership or employmenl based on race, color, or national origin.

sign, -=^.Authorifed Signatur;

Chief Administrative Officer ^-/j^/^gTille Date '


FAPPROVAL

D DISAPPROVAL

COMMENTS: ..


D APPROVAL

D DISAPPROVAL

COMMENTS:

Authorl.ized Signature Dale

Nebraska Dcpartmont of Revenu;96-253-2006 Rov. B-201) Superaedas 9S-253-2008 Rev. 5-2009

Aulhorized by Neb. Rev. Slfll. §§ 77-202(1 ){c) and (d), and 60-3.185. anti 60.3,109


Documents

Type of Ownership BUS REVENUE FORM PICK-UPlancaster.ne.gov/clerk/agenda/2018/180508/mv.pdf · Julte Spader, 14880 Old Cheney Road, Walton, NE 68461 DESCRIPTION OF THE MOTOR VEHICLES