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gren_--z— 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 /> =min-- .'n •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 ❑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 <br /> President Jeanne Mueller-Fossberg 608 White Ave. Grand Island NE 68803 <br /> Superintendent Steve Osborn, 982 Joey Circle Grand Island NE 68803 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> 1 Motor Vehicle Make l Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> if Newly-Pui,.hased <br /> Chevrolet Truck 2017 Subarban 1GNSCGEC4HR125299 1016/16 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 111 Agricultural/Horticultural ® Educational 111 Religious [11 Charitable 111 Cemetery <br /> as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist ®YES ❑NO <br /> Vehicle used for transporting students to school activities. If No,give percentage of exempt use: <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 1 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 CLIOc ^ 440_✓ /0-t1 -/Jo <br /> here A Tide Date <br /> L. FOR COUNTYTREASURER RECOMMENDATION p — /11"‘‘ <br /> %APPROVAL RECEIVED°MMEN-S: �RE/ Gj— 14 . 4=2 <br /> ❑DISAPPROVAL <br /> OCT 1 1 2016 /©i4 iC <br /> Signet f County Treasurer Date <br /> HALL COUNTYOR COUNT r BOARD OF EQUALIZATION USE ONLY <br /> AKA ND ISLAND,NEBRASKA <br /> Al APPROVAL COMMENTS: <br /> Ell DISAPPROVAL <br /> AlleiffeljPri AS <br /> f <br /> ,•rfr.ri e.To atU� ate <br /> Nebraska , ate <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1$0)and Id),and 60-3.185.and 60-3.189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 - <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />