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� - Application for Exemption iRM <br /> Nebraska Dep :insen[on I <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> *To be tiled with your county treasurer. <br /> •• •Reed instructions on reverse side. I j <br /> Applicant's Name i Type o ip <br /> Ownersh <br /> DIOCESE OF GRAND ISLAND Nonprofit <br /> Street or Other Mailing Address County • <br /> Corporation <br /> 2708 OLD FAIR RD HALL <br /> 0 Other(spediy): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Tige Name,Address,City,Stale,Zip Code __ __ _ _ _--_-- <br /> &`f.��'hof/Press dent 3.7, - )1 G. tit e,€e-at d7o8 FAIR Rd, ward rsJawd Al b fr$o3 <br /> k1 c; Pres dekt ('424 s G loaf 7/ x6353rea,a,:lArre, C4 4- iea 4/4 d&kb-3 __—___ <br /> S..ci-titi y re45ctPar sTitailAtL f itizlkkerwoet •ea.,� CoIkgt Der U€) S,d 3,7 Alt Log/ba <br /> J DESCRIPTION OFTHE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year eody7ype Vehicle ID Number Data of Acquisition, <br /> If Newly Purchased <br /> I-1 u ma It I P-009 re.n es es --K rfl ff G C 5eb Egg <br /> —� oloog 6-6 1 G-AZF57878'f i5l4'O <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaMorticulturai ❑Educational Religious Ii: Charitable ❑Cemetery as indicated? <br /> Give detailed description of use.Including an explanation d multiple use classifications�ex[st / f YES ONO <br /> -TA esc. Vali G/es 4Re. Used so lei deY rq ie¢e/C/kt..p-,let, 4. trerAada-� <br /> Celt j1 If No,give percentage of exempt use: <br /> Under penalties of law,I declare that i have examined this application and that KM,to the best of my knowledge and ballet,true,complete,and correct.I <br /> also declare that I am duly authorized d 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 J� .�/ !�/ 'P- ioewy /� �a Jaey7 <br /> here #!� = .— -i - – — --- l <br /> O A ized Siymatute Title Dare <br /> FOR COUNTY TREASURER RECOMMENDATION <br /> [ APPROVAL r^nMMFNTS: t;an 1sac /1-1 S' S ~l' -c��oZ� <br /> []DISAPPROVAL RECEIVED <br /> EC 1 4 2017 0 Signature of County Treasurer Date <br /> I FOR COU■TY BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> TREASURERS OFFICE <br /> [a APPROVAL GRAND ISLAND,NESRASMMM ff NTS: <br /> ❑DISAPPROVAL a- <br /> II . i ,. 7-718' <br /> O. ., find Signature Date <br /> Nebraska Deparbrant of Revenue Authorized by Neb.Re,.Stet.§§77-202(11(c)and(d).and 604.185,and 603,189 <br /> 96-253-2006 Rev.6-201:Supersedes 95-253-2006 Bey.5.2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />