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6)017 <br /> imp— Application for Exemption FORM <br /> Nebrt fra Depanment of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be flied with your county treasurer. <br /> •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> GRAND ISLAND CENTRAL CATHOLIC SCHOOLS Fr Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 1200 RUBY AVE - HALL ❑Other(spxty): <br /> City Slate - Zip Code . State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> eirt51 • -Al. A. At '4-"_ ' 6.L i A A 1 tie <br /> i <br /> t <br /> Vii. , I �. . l.qq / , - . :r <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 UP Number. Date of Acquisition, <br /> If Newly Purchased <br /> PACE 2001 ENCLOSED TRAILER ' 472F810131X016080 <br /> - <br /> CHEVY 1987 BUS , IGBJ6PIB3HV105159 <br /> 9i. 1302 VAN- 20D11031M004301121 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturallHorticultural I)GI Educational ❑Religious ❑Charitable ❑Cemetery as Indicated? <br /> a.../ <br /> Giveee detailed description of use,including an explanation if multiple use classifications exist: $YES ❑NO <br /> 1 /t/n �(y 145c„/ 4i r 1f JTh%S/b l4r Vs S1u ( If No,give percentage of exempt use: <br /> v /L 'lb �1�( C�r�Viui1ieo. n'kJ %cle <br /> Under Wallies of law,I declare that I have examined that the of exam etl this application and the is,to he best o knowledge and belief,true,complete,and correct. <br /> Pe naq owning 9e p irate <br /> also declare p or I em duly ent authorized on sign this exemption national origin,and that the organization owning the above-listed property does not d�scnminete <br /> in membership or employmatrt based on race,color,or national origin. <br /> Sign t�.�, .ter-- - S urrt ,n, /C-.2714 <br /> here Authorized Signature Tele Date <br /> FOR COUNTY TREASURER RECOMMENDATION -S J <br /> Q APPROVAL COMMENTS: ✓r �A- dVr `T . "7 7 `2o. <br /> ❑DISAPPROVAL / /7 <br /> % '1' o\°61' / mod' /� <br /> Signature of Coty Treasurer Date <br /> I FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> p APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> PO'Authorized Signature Date <br /> Nebraska Department of Revenue Authorirea by Neb.Rev.Stet§§77-202(18c)and 60,and 80-3,185,and 60-3,188 <br /> 96-253-2006 Rev.8-2011 Supersedes 98.2532006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />