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eien--_-- Application for Exemption AOI4 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 Marling Address County Corporation <br /> 112 S CEDAR ST HALL <br /> ❑Other(specify): <br /> City Slate Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title (Name,Address,City,State,Zip Code l �`- / �t <br /> Res:ra�t 6ihop (f(,Iirpm l w.lirc.er .3i/Li71h 6112nel (U_Nr <br /> �VccrP Prrcrlrnt ft Cbartrc. `fo({c v ,3^PI,,U S LNc c cStttur kind 'I <br /> f(°r.c..ref F 1`u chor-ck Pon+dtrsk: »'t3� 5 f; n-A I�f oack,S-stun Jµryv <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> If Newly Purchased <br /> nod Re c.)-00 5 5port Von 'IytO5Vticr3687 g'opal 5" <br /> Chet- Dan Q t3(tte.b(cci 3(J=x/41)53735 7.1-13 <br /> Are the motor vehicles used exclusive <br /> Exempt Uses of Motor Vehicle: �./ exclusively <br /> ❑Agricultural/Horticultural I R Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> j�Give detailed descrpthn of use,inducting an explanation 6 multiple use classifications exist: t %YES ❑NO <br /> YVA rr■04-11 �:5c. 6ki nspocit�.'harx a d(i4CRtct cncl + I(}(t f, C.Jl� \ © fl If No,give percentage of exempt use: <br /> -Rek6 lies oc o41ec school -rmt ,oc vr,en. Mot.; Sic use)d b� tki , 1, % <br /> d'oc cots -ts oc oi►tcc s;a.;kt .octanes J <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 ar employment based on race,color,or national origin. <br /> sign ����0 / <br /> here e I Aut rized Signature Title 7 /T�5 Date <br /> cbv lor5 <br /> L FOR COUNTY TREASURER RECOMMENDATION <br /> 'APPROVAL RECEIVED COMMENTS: .44.y 14- 7,7GZ <br /> DISAPPROVAL o°oaelcc� <br /> A <br /> ®l kaw1AVir /)2-/`n-/S- <br /> ■Signature of County Treasurer Date <br /> r TREK“ALL <br /> TREASURERS COUNTY BOARD OF EQUAUZATION USE ONLY <br /> ORA,vs.ftAivD,NESR71aF3) <br /> .[APPROVAL COMMENTS: <br /> ❑DISAPPROVAL set <br /> "Aber tirr, <br /> Aut.•razed '.n: re '- ° rate <br /> Nebraska Department of Revenue Authorized by Net Rev,Stat.17y-202(1)(c)and(d).and 663,165,and 60-3,169 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />