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IlliVn------L— Application for Exemption a C 1 V 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 /> DIOCESE OF GRAND ISLAND ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2708 OLD FAIR RD PO BOX 996 HALL <br /> ❑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 /> T:sLcp/�/?reszctr? tai' ,roceplt rr,/-la ne-�eId{; aiO ' oid fry=r Rd Gra=nd S5/a..d,NE ('Kb- 3 <br /> V;ce I)res.wevlt C.&rit5 b To(Fey R6 35" $renn eel 1a-tn.e) craw J LSJt d,JVE 68-sjo 3 <br /> Sec irk ty fry-e43b:,'-er M;tim e F- P'tc.Utrdneft, Y/IO Ca-„no, (Read Graa4 tstc"nd, 7UE (G Ge-o 3 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year I Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly Purchased <br /> Nywndu i G-e.ry2s Ic aoo ? 5e eta_n kM h`6-C Yto Egygoya s-O (0 <br /> Exempt Uses of Motor Vehicle: ml-� Are the motor vehicles used exclusively <br /> ❑AgriculturaVHonicultural ❑Educational eligious charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple'''use.classifications exist: ONO <br /> TLes ve1ttc.1-e is used sole 11 -`r r'el:(5 +ahs ti tsr ) 4-4-61e <br /> If No,give percentage of exempt use: <br /> Under penalties of law,I declare that I have examined this application and that d 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. <br /> sign <br /> (;74,47(4,4_Jrn 4 Nrv- //,aai, <br /> here rized Sign Title Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> E1 PPROVAL R C IVEDOMMENTS: �}�` �� � '``� " <br /> f Y a4-reegss <br /> ❑ DISAPPROVAL , agI 9e, <br /> Ri_ a ";.0 � :' /4 /� /�-.. <br /> Signature of County Treasurer Date <br /> HALL COUNTFOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURERS OFFICE <br /> GRAND ISLAND,NEBRASKA <br /> APPROVAL COMMENTS: <br /> ❑ DISAPPROVAL / / / <br /> t r <br /> e.,4i.‘ /iii / / /0. <br /> A irorized Signatu'- r male <br /> Nebraska Department of Revenue Authorized by Ned Rev.Stat.§§77-202(I)(c)and(d),and 60-3,185,and 603,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />