Post on 18-Feb-2019
^%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
3400 Sheridan Blvd Lincoln, NE 68506
3500 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 Sign^ure ^
•^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^
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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
LancasterState Where Incorporated
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
FOR COUNTY TREASURER RECOMMENDATION
FAPPROVAL
d DISAPPROVAL
COMMENTS:
4^^z.1 Date
FOR COUNTY BOARD OF EQUALIZATION USE ONLY ^C]APPROVAL
H] DISAPPROVAL
COMMENTS:
Authorized Signature Date
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
PLEASE RETAIN A COPY FOR YOUR RECORDS.
N«bra»k» Department of
REVENUE>a.riu«iu-»,m«rn^*rir
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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$ko\
Typa of Owiarahlp
ES NcnproIHOorpo ration
D OUw (spBClfy)!
IDENTIFY OFFICERS, OlRECTORS, OR PARTNERS OFTHE NONPROFIT ORGANIZATIONTina Name, Address, Clly, Stato, Zip Cods
Pce'nAevA' £.llev\ Ai<;oA\/o loo N W\\- <,T L^f;^, N^ fc^O^
DESCRIPTION OFTHE MOTOR VEHICLES•Attach an additional sheet, If necossary.
Motor Vehicle MaKe
^ Set tttia-.^A -^OVVA
Model Yaer Body Type Vehicle ID Number
ixsmpi uses of MoiorVehlcls;D Aflrioullural/Horlkiullure) D Educational D Religious |2) ChariiaMs D CBinBigry
Give detailed descilpllon of UBB, Including an BXplanatton 1( multiple use classlllcaltons exist;
M VeV:cU$ol<e Vc.cA -^or ^e pv^po^ 0^ Co^k^AP) w^dilivpry o1? b^ooA,
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
PLEASE RETAIN A COPY FOR YOUR RECORDS.
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
Nebraska Department of
REVENUEnfiriaiiw-'s'si"--"™"
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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
457Type of Ownership
g] NonprodlCorporation
D Other (specify);
IDENTIFY OFFICERS, DIRECTORS, OR PARTNERS OFTHE NONPROFIT ORGANIZATIONTills
President
Presldent-ElsctSecretary / Treasurer
Name, Address, City, State, Zip Code
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
Registration Date orDate of Acquisition,If Newly Purchased
200820082008
Are the motor vehicles used exclusivelyas Indicated?
^] YES Q NO
If No, give percentage of exempt use:
.%
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-^uTh(^e<^nature
Director of Business & Finance 4/17/18Title Date
FOR COd^n^EASURER 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
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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
457Type of Ownership
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 ^uio
^Are 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 ^Authorized Signature
T^e^^-e^Title
r2^^^o^?Date
FOR COUNTY TREASURER RECOMMENDATION
'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
PLEASE RETAIN A COPY FOR YOUR RECORDS.
Nebraska Oepartmunt oi
REVSNUE5£Pl3dsd'S'ift%!:I'.-yLTj'f3!l'd
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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
!^aL//> ff^iAjL^i-?/»Jl <^_ /->(^^(J-«*V/-
i^tirJ ftc^iLv^^.x^'-Ai/f- ^(^A/
Name, Address, City, State, Zip Code
't^MLy^ 3m ^r^ hfi^. C^'/- ^&(a??o^\r^ f-^k^ i ^Stfq\rMtr^£>r. ^^cet^ /J5 CK<&'L-'^n^[t'^^,^\ <J^A^ ^^ ^r/^ f.'i^»f^J^^$/^l^.e^ '^^L^L> fYo? ^^A^'- L(/tCo^"'JL^^l^^
DESCRIPTION OFTHE MOTOR VEHICLES•Attach an additional sheet, if necessary.
Motor Vehicle Make
_^<>rc>
Model Year
^T.3
Body Type
-C^i^.
Vehicle ID Number
^QS52Q L- Wfi S>^«?/_
Registration Date orDale of Acquisition,If Newly Purchased
^/v-
^-
Exempt Uses of Motor Vehicle:
I] Agricullural'Horlicultural (^l Educational II Religious || Charitable |] Cemetery
Give detailed description of use, including an explanation if multiple use classilications exist;
Ve-k>Jo- \S u$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
If No, give percentage of exempt use:
.%
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"
FOR COUNTY TREASURER RECOMMENDATION
APPROVAL
D DISAPPROVAL
COMMENTS:
^-/rDate
FOR COUNTY BOARD OF EQUALIZATION USE ONLY
Q APPROVAL
Q DISAPPROVAL
COMMENTS:
Authorized Signature Date
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
PLEASE RETAIN A COPY FOR YOUR RECORDS.
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
[^^r^e^Name. Address, Clly, Slate, Zip Code
^-e^^oL^ ^soi ^..^\^1L^^^ t^^tcr^^&or^ / ft^ll C^OS 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-
Exempt Uses of Motor Vehicle:
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 ~^« ^^Ac/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 Ih^eal 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.^^ £^UL.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 Tr^auier
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
Nebraska Department of
REVENUEia:nia3:ir».i;Ki»-i.-n]a.-r
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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
457Type of Ownership
^ 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
Exempt Uses of Motor Vehicle:
[_] 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
Are the motor vehicles used exclusivelyas indicated?
^ 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.^olor, or.-national origin.
si9", ^-^W/W^^M.^-^Aulhonzed .Signature
Director of Finance 4/23/2018
'..'•' <-"7Z: Tille Dale
FOR COUNTY TREASURER RECOMMENDATION
APPROVAL
D DISAPPROVAL
COMMENTS:
Signature of Coun|y Treasure
FOR COUNTY BOARD OF EQUALIZATION USE ONLY
^ i^\ SDale
Q APPROVAL
D DISAPPROVAL
COMMENTS: ___
Authorized Signature Date
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
PLEASE RETAIN A COPY FOR YOUR RECORDS.
Nebraska Department of
REVENUElaii'im.trr-w*"''""'
Application for Exemptionfrom Motor Vehicle Taxes by Qualifying Nonprofit Organizations
•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
LancasterState Where Incorporated
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,
Registration Date orDate of Acquisition,If Newly Purchased
5-22-06
7/2006
Are the motor vehicles used exclusivelyas indicated?
^ 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 '
FOR COUNTY TREASURER RECOMMENDATION
FAPPROVAL
D DISAPPROVAL
COMMENTS: ..
FOR COUNTY BOARD OF EQUALIZATION USE ONLY
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
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