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�a/3 <br /> -- Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> •Applicant's Name Type of Ownership <br /> ST MARYS CATHEDRAL/CATHEDRAL DAYCARE ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 112 S CEDAR ST HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code "� <br /> ',y�c .∎ r°ntt tat l WILT fLnk, •c 311 W 17x4, L"xU�T4nnd, Nt <br /> V fee PtrciAent Pc dloclric,lorip ..)17/O 5 Ainpi.e fc,nclTr4nnd kc <br /> lir ucuccs A R;(4,:(-3. Pnrr 4� e )7 S Corn ccsnA-[klcrnA Ali <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> _____ Motor Vehicle Make - -_.AlodelVear -...Body Type__._. __.. . Vehicle ID Number _— --- -Date of Acquisition, -if Newly Purchased <br /> (`1c-O'y ra0(D7 C;liurbcJ. 1&3H G31(9 ViaGtiy,' 7-I-1a <br /> Exempt Uses of Motor Vehicle: �.l. Are the motor vehicles used exclusively <br /> ❑AgriculturallHorticulturai eA Educational 'Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: IV YES 0 N <br /> e, ()Se 4c {`C tz\tcon C de « c - .SC.\-‘00 <br /> b Si�cc� percentage p <br /> If No,give ercenia of exam use: <br /> -el -fr,, cc cc kcc `ckook t-conceoc-tat'locl . (110.4 e us«�. <br /> C"GS(SYv J( cchcokS 0 ç 0-4,ec Stn ciC purpoccc s . <br /> Under penalties of law,I declare that I have examined this application and that it is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign - P--w4 9 Safy ft/Pot c, / a <br /> here Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION 1 <br /> RECEIVED G N mss 77- tea, <br /> E APPRe AL Cr MMENTS: /Q'� <br /> ❑DISAPPROVAL ' p'? <br /> 4k° - - '.--1 /,/0074 -i g <br /> HALL COUNTY r Signature my Treasurer Date <br /> IRE ,C - <br /> • dD 15:'.AND.NEDPASKA FO' COUNTY BOARD OF EQUALIZATION USE ONLY <br /> ePPROVAL COMMENTS: <br /> 1 <br /> ❑DISAPPROVAL <br /> i <br /> 0 _ ��/_ '_-St _ _/" _ — / . 1' Ar02o13 <br /> Authorized Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />