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WoZ3 <br /> t.---r_— 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 /> • <br /> GRAND ISLAND CENTRAL CATHOLIC SCHOOLS ®Nonprofit <br /> Street or Other Malting Address County Corporation <br /> 1200 RUBY AVE HALL <br /> Other(specify): <br /> City State Zip Code Slate Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title�� `j;���' I Name,Address,City,State,Zip Code y^t�� <br /> �Lnpe et(del Sfeve a Yi .2673 Div fHher Gdr� NE-(aR516 � <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> /9 <br /> •Attach an addition�}al sheet,if necessary. p� <br /> ACC o7.00, E# c/o`ted Thiler 7ZFhe /ertghtO/4p)Zv Registration Date or <br /> oto Vehicle Make Modell/ear eotl e i e member Date of Acquisition, <br /> • • r ;.oa es - _i: -4 ‘ L 'i . A/5" if Newry Purchased <br /> raprivisartramoninnos <br /> EIMMEISININSIMIIIIMOISIMISIIIIMIIIMItteatelP11 <br /> Exempt ses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural $Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,Including an explanation if multiple use classifications exist: <br /> / / ) $ S ❑NO <br /> • li`--'liC-ft el t bed 4r- a h5ro •' .s /'1 s. ./ If No,give percentage of exempt use: <br /> �9 L("1�.�4J (rte <br /> school C1C1(ur4-(ea . l(// <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 membemh�ant based on race,color,or national origin. <br /> `� sign S nni-e L- &- /.2. -& �- , <br /> here 1 Authorized Signature Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION i <br /> B APPROVAL COMMENTS: d14212-4--) AISS 77 e2C7 a-- <br /> o DISAPPROVAL <br /> `44°1(;a /..,7 tea----Q <br /> C a• l/Signature of County Treasurer Date <br /> I ��VEDOR COU BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL DISAPPROVAL 7 V DEC C _ 7 2012 <br /> COMM TS: <br /> 0 DISAPPROVAL �J <br /> HALL COUNTY <br /> TREASURERS OFFICE eilsa// iA� � /.5-- O .3 <br /> • — <br /> GRANO ISLAND,NESRAKSA onz dSlgnatur <br /> Me <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet.§§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 />