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� �%� <br /> ��--�-- Application for Exemption �- <br /> Nahraska Pepartment of FORM <br /> REVENUE from Motor VehicleTaxes by�ualifying Nonprofit�rganizations 457 <br /> •To be filed with your county treasurer. <br /> •Read instructions on reverse side. <br /> ApplicanYs Name Type nf Ownership <br /> B�NEDICTINE SIST�RS �Nonprotit <br /> Street or Other Mailing Address County Corporation <br /> 2939 PINNACLE POINTE �R HALL �other(specily): <br /> City State Zip Gode State Wher�Incorporated <br /> GRANp ISLAND NE 68$03 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PAR7NERS OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,Ciry,State,Zip Code <br /> r��G��eSS - '-�2� I �in �2_� _ <br /> 5 S� e:-; �) S l�[ o-K _ <br /> 1(?a� t.t) � F3�'� <br /> a,�.lt, a� � D .��p} <br /> DESCRIPTION pFTHE MOTOR VEHICLES 4 <br /> •Attach an additional sheet,if necessary. <br /> Registrsti�n 4ate or <br /> Motor Vehlcle Make Model Year 8ody7ype Vehicle ID Number Date of Acquisitipn, <br /> if Newly PurGhased <br /> C�'R� c►� C��v � r.4F 3�1 3(,�tlx b� a � �^cw rs�--�-�F`,v� <br /> �5SGt� <br /> 1� �l <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ❑Educational �Religious ❑Charitahle ❑Cemetery as indicated? <br /> Give detailed description of use,including an exprlanation if multiple use classifications exisT: ) h f V�l�i c 1� i S tl�ed �YES �NO <br /> � �-C�nS�'�'at�On �ri'O� kti� KP W�� r� u.�y pi��C �F Nn i�n.�s+r-y C 13` l�sse d <br /> j'A{:CaY1ti�QMT 4�J�ft.�J $1'l� CYC�1�+N01 �'�` 'f5r�, o 1V'�I Iv�\S� r� •�+ ��Y��. �fV�1 G-�� \S D��IVBP EIR <br /> 1 S c���j6 V`�4�� -�'O di'IY2 'ro ��C�Ed �lfdr� MOtit�5�f�.t �O'� Y'2 �,G1 ��tl� ri' �� �� <br /> J � <br /> ytn-�2-}tti�^ 5 n T�'�.0 v e�ti C�-� �'n d d d,�`i ox fr� be i �r�.r[� �-a f P�i a 'O,.5 <br /> , ` � 5�e r-�� �p ' 1",O"vl�. 'f-e r i 5 �f�h #a D w�a�� �J� c c'� In <br /> µneQT S `t �r �re�$ ,,,���� p�� 5�5�-er$ �w. S�c:r�c� ���r� ' QEC - 8 2ni1 <br /> �,,.a 1z����� <br /> �"lav.z���e� . �t° ��, ��c �-aw.e,x�" C'I.��lr-c� � �U�� 38''-1- 05 3 ' <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,ep���C?UN"fY <br /> also declare that 1 am duly authorized to sign this exemption application,and that the organization owning the abnve-listed operty doeslt8t�O�FIGE <br /> in membership or empldyment based on race,color,or national origin. GRP,NC)i,_>I.�ND,NEBF;AKSA <br /> sign ..' . ��1v 1��1,�I Q�sko�al ,�`'��nis �--�t' ��f� /'� <br /> hereAu�d Signature � Title �ate <br /> FpR COUNTYTREASURER RECOMMENDATIpN � <br /> �APPROVAL COMMENTS� �� 11/�i. �/d�s �J�Tad� �� <br /> �DISAPPROVAL <br /> ` ,���/�.�•rJ - --/�� ��Z�'-/--ll <br /> Si nature of County Treasurer Date <br /> FOR COUNTY BOARp OF�QUALIZATION U5E ONLY <br /> �APPROVAL C�MMENTS: <br /> ❑pISAPPROVAL <br /> ����� <br /> Authorized Signature Date <br /> Nebraska Pepartment of Revenue Au[horized by Ne6.Rev.5tat.§§77-202(1)(c)and(d),and 60-3,185,and 603,189 <br /> 96-253-2006 Rev.8-2011 Supersedas 96-253-2006 Rev.5�2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />