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,0/? <br /> ..ten--z__. , Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be tiled with your county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> ST MARYS CATHEDRALJCATHEDRAL 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 /> fksdectc C3;' lathem CJencat'q 311 W 7-th Csuanrl ia� 'V <br /> Vie Pwc.r�erct rt. C.ho�s�c,r� 24110 3 G .rne. and s,un el,/V <br /> - Gr A. . ► e.t... _ - At r <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> I I I I. Registration Date or - <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br />• <br /> _ if Newly Purchased <br /> "12O Lb1Lr6icA I Gal 63 I F9YWS3135 <br /> Exempt Uses at Motor Vehicle: Are the motor vehicles used exclusively <br /> Educational Religious Charitable Cemetery <br /> as indicated? <br /> ❑Agricultural/Horticultural � � g ❑ ❑ N <br /> ^Give detailed description of use,including an explanation ii multiple use classifications exist: 1 I l 0XES ❑NO <br /> 1 C�['t'TJr l 1 ' hU .S9DV}O T'Q(Th o d(t,a}(e C?f1�. c-IN)01 Off c��trace � If No,give percentage of exempt use: <br /> 1111k c 1cps cc 0.-{9ec Scl c\ tray xxtut-roil - (r\s,be usc-c\ To <br /> Poc,'sh -40c celcex oc 04Ci,eC S;m,tCkC .Pu rears. <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 members • r employment b on r color,or national origin. <br /> sign U i, 5,,, (-,, 7No✓‘2,773 <br /> here /'Authorize Signature Title / Date <br /> RECEIVE OUNTY TREASURER RECOMMENDATION <br /> APPROVAL G LCOMMENTS: aE-✓ 4-1-,;;;....5: 7:- 7C,- <br /> ❑DISAPPROVAL O�`) t � G'� <br /> HALL COUNTY <br /> TREASURERS,Ol�F❑FI�CE ,Signature of County Treasurer Date <br /> 1 GRAND IDLAND,ffOR GOUN a-'JARD OF EQUALIZATION USE ONLY <br /> VJI APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Authorized Signature --- ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d).and 60-3,185,and 603,189 <br /> 96-253-2008 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />