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2�b16 <br /> 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 /> ST MARYS CATHEDRAUCATHEDRAL 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,Zp Code <br /> Hrc,ioeni- f skop CU,lrurn Ocrr%: c 311 L i 7> ■ ewan l nnt\ Aft <br /> - . . C • - ("tic.. r= <br /> th <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,It necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year I Bodylype Vehicle ID Number I Date of Acquisition, <br /> If Newly Purchased <br /> CVravI r•)l©r) Rldeb(c.k l<-Ib3N(-3 3 ( f 9Yla43735- 7/1/13 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agriculturawtorticultural ggducational ES,.Religious ❑Charitable ❑Cemetery as indicated? <br /> Give <br /> detailed description of use,including an explanation if multiple use classifications exist: YES ONO <br /> mI ru(L� U.SE' ` X '}Con5pfx�.�j-I nCI oc (y0 COO a(1d SCV 00 aje If No,give percentage of exempt use: <br /> Geld oc� etc).-+rips OF tscF J tifunSporicr-∎on , <br /> ()sea PGcs\-. 72cdc cct-eckts Cr Ofk\er Sr " <br /> p c <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 thatthe organization owning the above-listed property does not discriminate <br /> in membershi or employment based on race,color,or national origin. <br />• <br /> sign ////��/��� t1? S <br /> here I`AU herize Signature Title "S Date <br /> RECEIVED FOR <br /> kOUNTY TREASURER RECOMMENDATION <br /> APPROVAL COMMENTS: <br /> ❑DISAPP ROYAL NOV 2 1 2014 Al Z-9—Z- l <br /> HALL COUNTY <br /> TREASURERS OFFICE ,Signature of u yTreasurer Date <br /> 'r/, GNANU ISLAND,NEt3RAb $ nn,UNTY BOARD OF EQUALIZATION USE ONLY <br /> IL APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL 4 1MN <br /> 3 <br /> otl.- nat.- Date <br /> Nebrasla Department et Revenue authorized by Nell Rev.Stat.§§77-202(1)(c)and tdr.and 80-3,185,end e0-3,189 <br /> 96-253-2006 Roy.6-2011 5/pomades 96253-2008 Rev.5-2119 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />