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020/3 <br /> Nebraska Department Application for Exemption FORM <br /> REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> •To be filed with your county treasurer. <br /> ommonamsami •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> 0 SISTERS OF THE HUMILITY OF MARY ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 823 ORLEANS DR HALL ID Other(specify): <br /> City State Zip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title Name.Address,City,State,Zip Code <br /> Major Superior Sr. Susan Schorsten HM, PO Box 217, Villa Maria, PA 16155 <br /> Director of Finance CAthy WEiss, PO Box 313, Villa Maria, PA 16155 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br />• <br /> Registration Date or <br /> Motor Vehicle Make Model Year Bodylype Vehicle ID Number Date of Acquisition, <br /> __. ____ _ _ __ . _ ___ _ _ __ __ _. _ _. _ It Newly.Purchased _.. <br /> Chev. (97260080062) 1997 Geo Prism, 4dr 1Y1SK526XVZ457916 <br /> Honda (07331080056) 2007 Hon. Civic, 4dr 1HGFA16527L139430 <br /> Exempt Uses of Motor Vehicle: <br /> p Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ®Educational T]Religious ®Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation if multiple use classifications exist: ®YES ❑NO <br /> Geo Prism and Honda Civic <br /> OBelong to Religious Community. Used for transportation If No,give percentage of exempt use: <br /> to families in need. Used for Church calls to <br /> parishioners, hospitals, nursing homes, the homebound, <br /> other Church business, etc. <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 />• <br /> in me�mbeerrrsshhhii�p��or employment based on race,cowlloor,r,00r'national origin. <br /> �f <br /> • <br />• here Authorized Signature le� U ✓'_ D(/ ��''�lF <br /> FOR COUNTY TREASURER RECOMMENDATION I <br /> I a ROVA RECEIVED COMIENTS: law ■11-5:5 77- -rip -2- <br /> 0 DISAPPRO AL <br /> Pr Signature cl Cliffinty Treasurer Date <br /> HAIL o-COUNTY C OR COt NTY BOARD OF EQUALIZATION USE ONLY <br /> GRAND IS :;D,NEF+RASKA <br /> APPROVAL COMMENTS: ,314"" X•S`'S 77-Se.7_ <br /> ❑DISAPPROVAL <br /> va k //—91 '/2- <br /> Authonz-.. ignature Date <br /> e t; /— Ci 020 3 <br /> I Nebraska Department of Revenue orimd by Neb.Rev.Sled§§77-202(1)(c)and(d),and 60-3,185,and 60-3,189 <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />