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�-�% ' �" <br /> �►�� Application for Exemption FoRnn <br /> Nedraska Depanment af <br /> REVENUE from Motor Vehicle 7axes by Dualifying Nonprofit Organizations 457 <br /> •7o be tiled with ypur county treasurer. <br /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> SISTERS OF THE HUMILITY O� MARY �Nnnprotit <br /> Street or Other Mailing Address Counry Corporation <br /> 823 �RLEANS DR HALL []other�speciry): <br /> ���y State Zip Cvde State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY QFFICER5,PIRECTORS,OR PARTNERS OFTHE NpNPROFIT OFiGANIZATIpN <br /> Title Name,Address,City,State,Zip Code <br /> Sr 5us h 5 <br /> x 313 Villa Maria PA <br /> D�SCRIPTION OFTHE MO70R VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> 9e�is:r�tian Da:c or <br /> Motor Vehicle Make Mvdel Year eodyType Vehicle Ip Number Date of Acquisition, <br /> if New Purchased <br /> V <br /> Facempt Uses of Moror Vehicle: Are the motor vehicles used exdusively <br /> ❑AgricutturaVHorticultural [�Educational [�Religious [�Charitable ❑Cemetery ����t�? <br /> Give qetalled description pf use,including an explanation'rf multiple use classifications exisr. ��`C� ❑� <br /> Geo �rism and Honda Civic �NO,� � � � <br /> Belang to Religiaus Community . Used for transportatio <br /> to families in need . T1sed for Church ca11s to <br /> parishi�ners , hospitals , nursing homes, the homebound , t,���y � p 1Q11 <br /> other Church buszness , etc . <br /> Under penafues pf law,I declare that I have r,xsmined this applicadon and that it is,to the best ot my luwwledge and bel' f,Vue,cornplete,1fid1�L�1TY <br /> also_dedare ttiat l.am duty authariz_ed tp sign this exemption application,and that the organization owning the above-I' properry��it�d�ur��nF�'��� <br /> in membership or empioyment based on race,color,or nalional origin. ,�!'�'-%�.:!�Np,NEBR�SKA. <br /> sign � �,�i�ed.w � ��.� ---- ir���-�oi� <br /> here Authorized Signature 7itle �,e - <br /> FOR CUUN7Y TREASURER RECOMMENDATION <br /> Q,APPROVAL COMMEN"CS: �SFS ��^�-O� <br /> ❑DISAPPR�VAL <br /> � i:z-�g.- t J <br /> Signatuie of County Treasurer Date <br /> FQR COUNTY BOARD pF EpUALIZATION USE ONLY <br /> ,�APPROVAL COMMENTS: <br /> ❑DISAPPRpVAL <br /> =—�� '�� <br /> horiz ignature Date <br /> Nebrsska oepanmen�or aa�erx�e numorized by Neb.e�.s�a�§$n-z�(iHa)end(a�.and sa3,�as,and eo-a,�ss <br /> 8�253-20D8 Rev.&2011 Supersedes 9G2532006 Rev.rr2009 <br /> PLEASE RETAIN A COPY FOR Y�UH RECORDS. <br />