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Application for Exemption . (•� / (z) <br /> Nebraska Department 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 /> GRAND ISLAND CENTRAL CATHOLIC SCHOOLS ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1200 RUBY AVE HALL <br /> ❑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,State,Zip Code �i <br /> ii - . . J";1•.Itig Aff 60g 1,4)41 e, AL, Lv . EVS <br /> 6/Let rrrk)1-E,r4Lilt e]4-p ✓e 0)56,-,7-n 94)22 .7-clay Ci-r a, /Ut ieR <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> /� { <br /> •Attach an additional sheet,if necessary. p <br /> Pa I bilcS I En LI�Se 'Tialk Li 7 i rin/ la3ana(6 GE7(� Registration Date or <br /> ota Vehicle Make o e ear � I�Boodov Tydde in a? I unmer a! Date of Acquisition. <br /> C) ii. (f 'pc`j /'�4-0 1 4,46 tK45i/zit �L(ii'.li If Newly Purchased <br /> nea9, ty4 ( p"ai & Ca ugn i&4 5 LcIG 7 o2t <br /> r hei,vr,t c-- o?jtvi : , ,ay) tLcd /edict - b, iia Li b qli <br /> rr cuso ferg7 i. e ., 59 <br /> 11 F 1gA02 &21-191__ <br /> .1 lid <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgricuhurabHonicuhural Educational ❑Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation If mull le use classifications exist: <br /> frES 0 NO <br /> I) ' ! ` <br /> If No,give percentage of exempt use: <br /> C(Llc �E� L15ta 45;c- i f l( 1S <br /> a15�pr 'fyk4 S GCIC�i % <br /> ` X100 I CIC„, -fLt �( , { <br /> t. <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. <br /> sign I <br /> here � �� �vP<ri 1f2A.J�4-1{ ate °��rs <br /> thorized '.nature Title Dale <br /> FOR COUNTY TREASURER RECOMMENDATION / <br /> [/�APPROVAL RECEIVED COMMENTS: /-%�g ' /v`�`�' 777—z--1- 2.., <br /> ❑DISAPPROVAL y ry ;ct SF , <br /> t� 3 2015 comp !2---' : -_ <br /> 11 Signature of County Treasurer Date <br /> HALL COUNTY FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> TREASURI-HS Othlt,e <br /> -/ GRAND ISLAND,NEBRASKA <br /> ✓" APPROVAL COMMENTS: <br /> ❑DISAPPROVAL - z <br /> Air- !i <br /> A•--prized'i9 = ate <br /> Nebraska Department of Revenue Authodzed by Neb.Rev.Stat.§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rea 8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />