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Application for Exemption �DtS <br /> / <br /> Ne�brasks Department - <br /> of FORM <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 /> 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 Slate 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 /> 13:S Ito p /Presider + With-am TDend'n er, 90&nin! Gra-ad It/ard, Mt 618'02 <br /> 1/ice ?res;dew-r C/Lar/es h. licep_ .Z63S 'Brennen Cos.e (rtadrs/aa4 ,Q- 6sto3 <br /> Secreinry/Te,si xer Mao. E. /Yk�etineEl S/// &tote i PA, 644,4 rsia,kcd, NE 6f V3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make I Model Year BodyType Vehicle ID Number Date of ACquisaion, <br /> �I it Newly Purchased <br /> Yruadet i lovilSiS 3009 5"e_ci -a.- n KMHCC v6e ? 46y08; <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively��1.aa as indicated? <br /> ❑AgricultoalMOmcultuml ❑Educational Religious Charitable ❑Cemetery <br /> Give detailed description of use,including an ecplanation it multiple use classifications exist: J 'ES ❑NO <br /> I� / J/�'�, /i f/+cS �y pR./ b . le <br /> /x I.i 0-e/ t tie t s used efril r.e`y 1 'r re If No,give percentage of exempt use: <br /> t( �t % <br /> gwrPeS-P S - <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- , o/ <br /> sign �j� £1 /a -- /tilt z ,�here ►Au hod lg re Date FOR C UNTY TREASURER RECN DATION <br /> r <br /> ? t Aa, .y 4 $ 77 23.2, <br /> PPROVAL `"""NTS: <br /> RECEIVED <br /> ❑DISAPPROVAL <br /> "014 Signature / — " <br /> DEC C /Si nature reasurer Date <br /> FOR COUIS TY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY OFCE <br /> APPROVAL GRAND ISLANDS EBRASMAMMEVTS: <br /> ❑`DISAPPROVAL 4 / <br /> ./1117 or .a// /-i 3 i <br /> thorized Signature / Date <br /> Nebraska Department M Revenue Authorized by Net Rev.Slat.NTT-202M(c)and(d),and 60-3185.and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2008 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />