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2011
<br /> TO BE FILED WITH Application fior Exemp#ion �oRM
<br /> from Motor Vehicle Taxes
<br /> YoUR COUNTY by Qualifying Nonprofit Organizativns 457
<br /> TREASURER •Read inslructions on reverse side
<br /> ._ _.,.. _ ,_._.,...
<br /> —....._.._ _.,.. —_...,...
<br /> Applicant's Namo County Type o wners up
<br /> SZSTERS OF '7'HE RU2`Z�LITY QF MARY H�AT,T. . ......._ �Nonprotit
<br /> �
<br /> Street or Other Mailing Address County Nurnber Corporation
<br /> $�� �RLE�lNS DR _. �+� _. ❑dther(specify):
<br /> ... _.,. ___.,._...._..,.�...,... .
<br /> City State Zip Code State Where Incorporated
<br /> G��p Z.�T�ANI� NE 68803 NE °--
<br /> -- ------_.. _..
<br /> idenlify Offireis.Directors or Partners
<br /> --- _
<br /> Name,Addre' - ----_ _...
<br /> _ .. _,.--.
<br /> - ---
<br /> 7itle ss,City,State,Zip Code
<br /> ry f
<br /> . _..._
<br /> i J��LTPL'RIUR Sk� . ST��AN SC�Ol��`:CEN HM_.,_
<br /> ___._...
<br /> � -� � �' PO BCJX 27. 7, V.TT,T,A �%T��T.A., P-����.55
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<br /> ��1kECTUR OF �'1NA�j(�. ; CATI1Y WI:1SS, PO ._�.C)X 3.13, VT.I.�I,A NinRTA., �-'z��,�,1-E..�.-��.---
<br /> _ _....
<br /> -- - . _...._.....- e i tration Dale �
<br /> LIST SPECIFIC DESCRIPTION OF7ME MOTOR VEHICLES
<br /> •Attach additional sheet ii necessary
<br /> Vehicle Mak Vehicle Ide;ntitication Nurnber
<br /> _.....
<br /> __ _.,.
<br /> -
<br /> R.gs or ae
<br /> � � Model Year Body Type of Acquisition if Newly
<br /> Purchased
<br /> _.__
<br /> —
<br /> ---- ..._._— _..----
<br /> - . ---
<br /> C�ic�v. 972�00�00`2 1,�7 c�o 1'I2�SN", 4 _d 1.��XV�a��a�_, ---...,_.
<br /> �_.. . _..,.
<br /> _, _._.
<br /> ---. ,
<br /> �?onda 07_ :3 08005�)' 20(77 ,c�n .Civlr... ' 1L��E�1..��2�T.1 �.�a �
<br /> -�- - -.. _.._. _ _. __ _._...- ---.....—
<br /> Nature ot Use of Motor Vehicle: Are the motor vehicles used
<br /> �Agrir,ultural/Horticultural �.Edur,ational �Religious ��arita6le �Cemetery
<br /> exclusively as indicated?
<br /> Give de/ailed description of use,including an explanation if multipl�classifications exist: �p� ����
<br /> par
<br /> � � ic�_� �s czvzc .
<br /> It No,give per�entage: _/
<br /> B�,7_ong to Rela.gi.ou� Comzr�unity . iTsed for t.rans}aor. - ---'
<br /> �a�ic�n to f�.milie� in rieed . Usc��d for CYila.rch Culls to
<br /> parish.iorier�, hospi_tals, nv.rsincr homc�s, the r�omebound, �Q� � � ���
<br /> other CY�.urc�1 bti.isi.z�ess, etc .
<br /> HALL COUN7Y
<br /> 7REASURERS qpFICE
<br /> . _. _. _...._. �. . _..
<br /> '�'_""�'ti,�'rc�ft�.�i64
<br /> Under penalties of law,I deelare that I have examined this application and,to the best of my knowledge ,
<br /> compiete.I also declare that I am duly authorized to sign this exemption application,and that the organization owning said property does not
<br /> discriminate in membership or employment based on race,cvlor,or national origin.
<br /> . � � � /� Jfi� �'- r// - f � �
<br /> s�gn � ' 1 --
<br /> � .��-_����� �%- .��—�Ui c�
<br /> .�,-.r ,,,, , ,.�Ti;.c�-��� !!f Lt---f!_.7�"�/?'� T�%L ( r-t� i��;�.�: �r..
<br /> here Authorized Signature Ti e Date
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<br /> FOR COUNTY TREASURER'S R�C�MMENDA710N
<br /> �.... _ ... __ .__ — _,,.,--- --- ..,_
<br /> [�fCPPROVAL COMMEN7S: �� �SS...,/ �"�G'� , —
<br /> ❑DISAPPROVAL - "'
<br /> � ?°��' � . _ �'f -��/Z'—
<br /> Signature of County Treasurer Date
<br /> .. � ._ _....,_
<br /> �.._ � _ ---.—.....
<br /> � FOR COUNTY BOARD OF E�UAL.IZATION U
<br /> ❑APPROVAL COMMENTS: _ _,...... __... ...
<br /> i /
<br /> �DISAPPROVAL ----..._ � _.... . f..1.. --..,. " _,... _.
<br /> - � �
<br /> � _... �.
<br /> �. .. __
<br /> p/ . _ /4�i ._, _..._....
<br /> Authorized Signatur Date
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<br /> Nebrask2 C70partmenl of Revenue � Au�horizt�d by Neb.Rev.Stat.§77-202(1)(C)(d),§60-3,185§603,189
<br /> 96-253-2006 Rev.5-2009 Supersodes 9G-253-20D6 Rev.ii-20�8
<br /> PLEASE MAKE A COPY FOR YOUR FiECdRDS
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