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eeL� Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be flied niaremEmm •Read instructions oncreve se side. <br /> Applicant's 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 OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> D;Sin.op /Pre sidetect boseppin G-. YFtnefeld f -nog did fir -Rd. Grt.nd $ Stand ?Jt 66'803 <br /> V;ce Pres.detat eha3les 1.,.Torpper 2635 12renaenLA- c.ancl Zs/sari Alb 68To3 <br /> See ire 44ry -Tretsurer Ili thee l F tit Peru/44 'f/+o ea nno n Rd. Greyed ZSland W 6 6803 <br />• DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Veh!ota Melee Mode!Year Body Type Vehicle pp Number Date of Acquisition, <br /> If Newly Purchased <br /> HYANDAI GENESIS 2009 SEDAN KMHGC46E994040806 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational %Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: gl YES ❑NO <br />• Ty S ie.- de ;s used solely for rtt as/c-444-r; k <br /> If No,give percentage of exempt use: <br /> 1Darp°SfS . <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 duty 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. plant_nt ` 30�.- 38-a.— 6 5-4p r <br /> sign //dui 4r.t,. ✓f/ A• .�.� ° 4>rsn/fhDP - f?Eslos17i ibineArist 07/,20/1 <br /> here ' I prized •.ignatur, f Title Date <br /> I • RECEiV217 OUNTYCREAS URERR RECOMMENDATION AL4$195 <br /> . X 77-2°a <br /> APROVAL COMMENTS: E-S-7)17 :2t <br /> 111 DISAPPROVAL NOV <br /> 2 8 2016 <br /> HALL COUNTY )16P1—.31-1° / a —/� <br /> TREASURERS OFFICE ' signature of Courtly Treasurer Date <br /> __— GRAND IbuwD ARD OF EQUALIZATION USE ONLY <br /> ❑APPROVAL COMMENTS: <br /> ❑DISAPPROVAL ✓J <br /> thorized Signatu Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Slat-§§77.202(1)(c)and(d),and 60.3.185.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 />