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<br /> ..n.—• 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 /> GRAND ISLAND CENTRAL CATHOLIC SCHOOLS ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 1200 RUBY AVE HALL ❑Other(specify):
<br /> City State Zip Code State Where Incorporated
<br /> GRAND ISLAND NE 68803 NE
<br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION
<br /> Title Name,Address,City,aSk.�tate,,�Zip Code �-
<br /> Y�e?O of 7e0 NNE,. rrr Llak..t�' FSSbpr 608 k/kile 41ve� 6�,Q 4I
<br /> 5gpertn onaLf • 10ve Osbor& — Y ,7 ,Tory Q.ir �•._8_ bRS23
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> PRce-_. I_E,ctoceeP stle-t I Lig F /d31 0/ CgD Regislratlon Date or
<br /> Moto Vehicle Make o tVear Body Type •nl .-l• 'umber Dareor Acquisition,
<br /> yi i ' of -� Est" j a�i Ill :I,,_' et es_.j if Newly Purchased
<br /> f�♦ !l� ,�Y7� Ja /L/ntit�lL' forMr�G?.s'Iras z a
<br /> ta,!!IT'� 5. I i I /uairtir ent ., 0 ' .
<br /> ra-� r7. r�
<br /> r.
<br /> 'du. naSIIIIIIII■ • ea_ 1/►1LIIIIIIIII=IPT)i.., •
<br /> Exempt Uses of Motor Vehicle: _ /' Are the motor vehicles used exclusively
<br /> [11 Agricultural/Horticultural Educational ❑Religious ❑Charitable El Cemetery as indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: ,YES ❑NO
<br /> • V ek J c-Q- CL9a r ll1 [�1 G� /-(,��1 ✓l/j (.l40 If No,give percentage of exempt use:
<br /> � [� J (J
<br /> TD f 1 - 'Ale,o.
<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 lam duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate
<br /> in membe hip or employment based on race,color,or national origin.
<br /> cc;,�i�v#; m i fit Kt,h w,'fie r , 8evysi�Pss �7a n4�e!—
<br /> 4/ sign �. � � S�JertaFe,�c At- lLA - -�O1 %
<br /> r- here ,Authorized Signature Title Date
<br /> FOR COUNTY TREASURER RECOMMENDATION I
<br /> PPROVAL RECEIVED COMMENTS: 2.17"t ✓tA. ?. . ...4„,'Y. .# ,/ ...?C`J
<br /> III USA xPROVAL „r.-, • r.,.. ,
<br /> LCt, b [via � p af2dAnk
<br /> HALL COUNTY Silr
<br /> Signature o" "fCounty Treasurer Date
<br /> TREASURERS OFFICE FOF COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> GRAND ISLAND,NtUKAbKA
<br /> 0-APPROVAL COMMENTS:
<br /> ❑DISAPPROVAL
<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.6-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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