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&J / 7 <br /> mri'---2_ Application for Exemption FORM <br /> Nebraska Depanmem of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be flied with your county treasurer. <br /> azurnimminil •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> ST MARYS CATHEDERAUCATHEDRAL DAYCARE ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 112 S CEDAR ST HALL ❑other(specify): <br /> City Stale Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68801 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zipr Code <br /> Pcrchdent h;Srip U1i�16yi�,nr. 3Xi 3Drtrr 311 1A1 74 (�lrunc -rslr,rvii ,t/E. <br /> Vire Prectr\ent t C ucle% Irx ?HO :S Rs:Na &furr Whin\, A/t <br /> 1G•nsoccr fr. . )lime'` (not KY. 0207 3 Elm &mnc Zs lurid,Pe <br /> DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make I Model Year 6odyTyPe Vehicle ID Number _ Date of Acquisition, <br /> if Fhmhased <br /> DODGE 2005 SPT VAN 2D4GP44L05R553687 <br /> CHEVYI 2000 CUTAWAY VAN(BUS) 1GBHG31F9Y1253735 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturauHorticuhural 4Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: EYES ❑NO <br /> Pc t l�llxiVN use ')C)C y t�}v , f1b 1 C, £ If No,give percentage of exempt use: <br /> v Co r� ut0 Sdu.t1 a % <br /> LeIc�cc ,,o r� �ielc�fps oc a s c- col�}rz�tmpa-i-c t�o n. !f a k <br /> l%S atos'77y cpcLS ' -CDC ce :tTS C C Cr{hc(Si Mn tut- perpo&c.,, <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 properly does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign au,,,,, IL 9-)A Ittasurt, 1L/z/ IL <br /> here 01—Authorized Signature Tale Date <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> APPROVAL >: /taw � .7-`Ql3a <br /> ❑DISAPPROVAL RECEIVE <br /> _ a /S—'Z <br /> DEC d,la <br /> Signature of County Treasurer Date <br /> FOR COUNTY BOARD OF EQUALIZATION USE ONLY <br /> HALL.COUNTY <br /> TREASURERS OFFICE <br /> APPROVAL <br /> ❑ GRAND ISLAND,NEBtUI tNIS: <br /> ❑DISAPPROVAL / <br /> Auth• .•i• Signature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat§0 77.202(9(0)and(d),and 643,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Per 5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />