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2011 <br /> 70 BE FILEDWITH Application for Exemption Fo�M <br /> YOUR COUNrv from MotorVehicleTaxes <br /> TREASURER by Gtualifying Nonprofit Organizatinns 457 <br /> •Read instructions on reverse side <br /> ----- ...... _. . __.__.... _.---- ... ..... . .....--- --- - -- . _ <br /> Applicant's Name County Type oi Ownership <br /> GRAl3D ISLAND CENTRAT� CATHOT CC SCHOOLS �1y� �Nonprotit <br /> -- _.- --. ., _ .- --- - - <br /> Street or Qther Mailing Address County Numper Corporation <br /> 12QQ RUBY AVE 40 _._..__. ❑dther(spocity): <br /> ---._. .__ - --- - ------------- -... <br /> City State Zip Code State Where Incorporated <br /> G�ll ISLANl) NE 6$803 NF. -° --- <br /> ----._.. -- __— ....__ _ _.... <br /> ----- � <br /> Identify Oificors,Directors,or Partners <br /> -- . _ — _.... ----.. .._ <br /> Title Name Address City,State Zip Code <br /> ---.. -- -- --- <br /> _ a <br /> .---- ----_ <br /> 'T''��c •�. . f,�' ►�� _ ��I� `�l c�7 -��,r.�i�r�g�iN�l�cP '�-,Z l�'_� � c� _ <br /> � <br /> - . , ---_ . <br /> _._�r� � r � -- r' ° �- .��'��� J� �� .�f��;��V�/lr'�'--('�1�._.__�}�X�� ���' �' — <br /> r��r._��-.4�- ---- � �.,. 1��R.�.� <br /> r�..� /ka '�!�� �Lr,����,�i� ��r`_ 'r_ - — <br /> --.. ... ...... ..------._ � <br /> _..... _. <br /> LIST SP�CIFIC D�SCRIi'710N OF7HE MOTOR VEHICLES <br /> •Attach additional sheet if necessary <br /> __. .. ....-.-- --- <br /> Registration Date or Date <br /> V icle Make Model Year 6ody Type Vehicle Identification Number oi Acquisition ii Plewly <br /> �1��.��� �r � r ' . ---- - /� � � � ���- _ <br /> Purrhased <br /> � ���� � -. , __.... ....�g.� __ �-,r�.�`,�.. � /f' ��T/�`tor�(o`��-1 .: . __ <br /> ��� . � _�� " ----- -�' � � c �� . ��,�/' �-- " ---._._ <br /> '>>• ���� � � c!�� _._ . .�c�.� —��- � , - � � � _./�ct �.� . <br /> P F�����- �' ° � l��`"� ,�1 ,3 �Q�� ----- _ <br /> _ __. _... _ <br /> _ . <br /> ��2C�[?�-'� - . • ��.i{. ------ r�r'��_`_°���1 '!�-.��-�/'31 ---.._. <br /> Nature of Use of otor eh cle: Arc the motor vehicles used <br /> ❑Agricultural/Worticultural Educafional ❑Religious ❑Charitable ❑Cemetery �xclusively as indicated? <br /> Give detailed description of use,inclu ing an explanatipn if multiple classifications exist: YES [.�NO <br /> —�,�-��-�..,..�_.. . �' r — -F�C�`�t-�1..— �""�-- ....._ _ Ii No,giv�� ta����/ <br /> �� ` <br /> � _ ,. . <br /> , , .� <br /> d - <br /> ��C..._.�'� �.E.:,S.._. <br /> _.,.._.--.. _. ��� � ���� <br /> � <br /> . -- -.�..... ....... , <br /> � � <br /> Under penalties of law,1 declare that I have examined this application and,to the best ot my knowledge nd pelief,it��a'c,eg��ql;�pFp�C� <br /> complete.I elso declare that I am duly authorized to sign this exemption application,and that the organization ow ing said�rqpe.�y�er�{�.N�pRASKA <br /> discriminate in membership or employment 6ased on race,color,or national origin. <br /> � ��� <br /> . <br /> Slgrt . , .� f �.. w�._a <br /> � <br /> _ <br /> here � � <br /> Authorized• nature f Title �ate <br /> ...... —_ � . ... . .... . _. --- <br /> �_ FOR COUNTYTREASUFi�R'S RECOMMENDA710N <br /> — .... .... ...... .— <br /> _ _ <br /> ; � /� <br /> [�APPRQVAL COMM[NTS: _ _� f �-�n�l�<l,. <br /> L]DISAPPROVAL ---.--..___.....__..— <br /> -----..._. . . ---....--- <br /> C�� � � � � J . <br /> _/Y'J..CU %✓ !/,�t:rV ��lc��.._.._.,.... <br /> /Signature oi County Treasurer Date <br /> _ ..,. -- -.. <br /> FOR COUNTY BOARD OF EQUALIZATION US�ONLY <br /> ❑APPROVAL COMM�NTS: <br /> s ; / - .... � � --..--.-- ! <br /> DISAPPROVAL , / .i � , v' i �`` �_ _-�-. �.___... .. --------... <br /> ❑ f <br /> �'' }� �.-�_ <br /> /Authorized Signature �ate <br /> Nebraska�eparunant of Revenue Authorized by Nab.Rev.S�aL§�1'7-202(1)(c)(d),§60-3,185§60-3,189 <br /> 96-253-2006 Rev.5-2009 5upersedes 96-253-20U6 Rev.t1-2008 <br /> PLEASE MAK�A COPY FOR YOUR RECORpS <br />