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��'�/� <br /> *�i��— Application for Exemption FDRM <br /> Nebraska Department oF <br /> REVENUE fram Mntor Vehicle Taxes by Glualifying Nonprofit Organizations 457 <br /> •7o be filed with your caunty treasurer. <br /> •Read instructions on reverse side. � <br /> Applicant's Name Type of Ownership <br /> DIOC�S� OF GRAND ISLAND �rvonprotit <br /> Street or other Mailing Address County Corporation <br /> 27Q$OLD �AIR RD PO BOX 1531 �A�-� ❑Other(specify)� <br /> City State Zip Gode State Where Incorporated <br /> GRAND ISLAND N� 68802 NE <br /> IDENTIFY QFFICERS,DIRECTORS,OR PARTNERS�FTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,Ciry,State,Zip Code <br /> Bisho Presiden� William J Dendin er PO Box 1531;'Grand Island NE 68802 <br /> harle L Tar e 2511 Del Monte Ave Grand Island NE 68803 <br /> f nnon Rd and Island NE 68803 <br /> D�SCRIP710N OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Rsgi^.•.�,i�n�2te:r <br /> MotorVehicle Make �odelYear BodyType Vehicle ID Number Date ot Acquisition, <br /> if Newiv Purchased <br /> H undai/Genesis 2009 Sedan KMHGC46E99U040806 <br /> Exempt Uses ot Motor Vehicle: Are the motor vehicles used exclusively <br /> �AgricuHural/Horticultural �Educational 0 Religious �Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classificaTions exist: YES �_aN0 <br /> ������ri�'1�' <br /> �'his vehicle a.s used en�irely for religious/charitable purposes IfNo,giv �e�ee� <br /> i <br /> � ._,.'. - � 2011 <br /> ���� <br /> HAi.L�C�UN7Y <br /> =t� <br /> Under penalties oi law,I declare that I have examined this application and Ihat it is,to the best of my knowledge and b ief,true,�c FP�pI�,���dr!�B!�P.K.SA <br /> also declare that i am duly authorized to sign this exemption application,and that the organization owning the above-list proper oes no iscnmma e <br /> in membership or employment based on race,color,or national origin. <br /> SIC�1'1 a � ���_Z.�7�� <br /> here utho ed_ignature Title Date <br /> bR COUNTYTRE,aSUR�9 RECOh".hREhDA710N <br /> Q'APPROVAL COMMENTS: �����' <br /> ❑DISAPPROVAL <br /> . ° `�'�e..s�il / -� -i/ <br /> Signature qf County reasurer Dale <br /> FOR COUNTY BOARD OF EGIUALIZATIpN USE ONLY <br /> �APPROVAL COMMENTS: <br /> ❑DISAPPRQVAL <br /> / - �. , <br /> ' �v r ` ,_ �y�-�--y�.._- <br /> AuthorizedSignature ' " ` Date � --�_^.'` <br /> Nebraska I]epartment of Revenue Authorized by Ne6.Fiev,Stat.§§77-2 n ), d , ,and 60-3,189 <br /> 96-253-2006 RBV-B•2D71 SupBY62dBS96•253-2006 Rgv.5•2009 <br /> PL�ASE RETAIN A CQPY FORYOUR REGORDS. �� E g E ; �• r �^_; <br /> 6[�ts_A_ � r�_:�\i � / � ; <br /> � ,� �� ,;,'� <br /> : � <br /> r ,,.,::�.:,+.�„�� <br /> :��'if1i�'';'�t4 ,a.°'�r� °._.�.�.;r,.e.;4 <br />