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ilikel- Application for Exemption FORM <br /> Nebraska Department of <br /> REVS from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> REVENUE <br /> •TO be filed with your county treasurer. <br /> • •Read instructions on reverse side. <br /> *pp Iicant'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 996 HALL ❑Other(specify): <br /> City State Zip Code State 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 PU Box 17i1 Grand Island NE. 68802 <br /> Vice President Charles L Torpey 2511 Del Monte Ave Grand Island NE 68803 <br /> Secretary/Treasurer Michael F McDermott 4110 Cannon Rd Grand Island NE 68801 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make ModelYear Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Hyundai/Genesis 2009 Sedan RMHGC46E99U040806 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational fl Religious Xj Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: [2IYES ❑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•aced on race,color,or national origin. <br /> sign i ''!.. a..✓. . ,i ii/4/26,1 <br /> here t o'ed Signature 's Title <br /> ER RECOMMENDATION <br /> OR CO YTREASUR <br />' [•''APPROVAL RECEIV tPMENTS: / r F�.� ,2%47t...5.. _7�-. ' <br /> i ❑DISAPPROVAL NOV 1 1 20 <br /> 1.1 V . d _Q•n,A J A- ;3-/'E' <br /> �• la .ignalure o Coun Sr Treasurer Date <br /> ______ sL '_ t4INihz kRali ARD OF EQUALIZATION USE ONLY <br /> }APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> • / d r� e ---- /—/ -ole,L <br /> /Authorized Signature Date <br /> Nebraska Department of Reverwe Authorized by Nab.Rev.Stat.§§77-202(1)(c)and(tl).and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2000 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />