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.07D /3 <br /> Ne�braeksDeof Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be filed with your county treasurer. <br /> missmanzamn <br /> •Read instructions on reverse side. <br /> illApplicant's Name Type of Ownership <br /> DIOCESE OF GRAND ISLAND ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2708 OLD FAIR RD PO BOX/I6i1 996 HALL <br /> El Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68802 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Bishop/President William J Dendinger PO Box 15.31 Grand Island NE 68802 <br /> • <br /> Vice President Charles L Tornev 2511 Del Monte Ave Grand Island NE 68803 <br /> Secretary/Treasurer Michael F McDermott 4110 Cannon Rd Grand Tsland NA 68803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. <br /> Registration Date or <br /> -Motor Vehicle Make --- ModelYeer Body Type - -- — Vehicle ID Number - - ----Date-ot Acquisition; <br /> if Newly Purchased <br /> Hyundai/Genesis 2009 Sedan KMHGC46E99U040806 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturallHonicultural 1:1 Educational fl Religious NE Charitable DI Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: DYES ❑NO <br /> This vehicle is used entirely for religious/charitable purposes <br /> • If No,give percentage of exempt use: <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 /> here � . _.._./ 0, . . — «L„t/ eh I/C1/z <br /> Authori =. i•nature r Title 7/ Da <br /> {^+ �` �-q FOR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL RECEIVED ICrgED COMMENTS: 7 ASS 77-ae7°2-' <br /> ❑DISALPROVAL <br /> J. , _ 0_ r�° �.� 7/— ?—�2. <br /> •I►Signature of County Treasurer Date <br /> 'Ma COUNTY <br /> TREASURERS OFFICE FO.i COUNTY BOARD OF EQUALIZATION USE ONLY <br /> eW,i.L_ S,.Ary,.rocoraa..wJ1 <br /> °APPROVAL COMMENTS: <br /> ❑DISAPPROVAL t <br /> e44244414g• crrsignawre 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 /> Po n e -1-t 30 S r - 3 g';-- 6 5-6 5' <br />