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020 /3 <br /> +dam-- oi Application for Exemption FORM <br /> Nebraska Department of <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •TO be filed with your county treasurer. <br /> rozzarsimi •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> • SERVANTS OF MARY SR RITA KOLBET ®Nonprofit <br /> - Street or Other Mailing Address County Corporation <br /> 821 ORLEANS DR HALL ❑Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> J IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Titlg I-C(,t?l J Me-4,42„... Name,Address,City State,Zip Code <br /> ArMry (2.vhrkh7Qr 7dad Mri14o0FyAu2 O-ma.kas Mc &jS+3EI <br /> _S• Mow,etre+ST1a1Wart 9'/x Al; Lieti-v Ave (")---ma het NE Cot/34/ <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> _ _-_ _ _ _ __ _.. _. _.. - _ if Newly Purchased <br /> fcrd 9Q171/a1024—S- 1 q q 7 L$ e °h.i 1.... K FA) P13P7VIONlt329 ft r] L , 01 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> 0 Agricultural/Horticultural fl Educational NI Religious ❑Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: I y*ES ONO <br /> At 1 ` -e e.1--; yr f i e.s �` <br /> t i i 0 N S J'" N I S f 'e 1"'�f- 0 hq �'� 14 d If No,give percentage of exempt use: <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 property does not discriminate <br /> in membership or employment based on race,color,or national origin. <br /> sign 2t�,14 free4 .4: ()AAA I/, t : I <br /> here !Authorized Signature The Date <br /> Frio,COUNTY TREASURER RECOMMENDATION I <br /> RECEIVED ss <br /> 1 APPROVAL 1 COMMENTS: �'�` /--- y �a�a <br /> 0 DISAPPROVAL NOV — 7 2012 • <br /> ih�" 'c a`F' //- 7—i2 <br /> HALL COUNTY • Signature of unty, Treasurer Date <br /> TRGtSuRnR3 Orrice <br /> ,,,Jtt..,,, a.—APPROVAL ISLAND,NEBRASKAOR C7UNTY BOARD OF EQUALIZATION USE ONLY <br /> APPROVAL COMMENTS: <br /> 0 DISAPPROVAL <br /> • u gnature Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(d).and 603,185.and 604,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />