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Id/3 <br /> •++^---L - 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 /> •Read instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> • BENEDICTINE SISTERS ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 2939 PINNACLE POINTE DR HALL ❑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 /> Pr'nress S;e PPllh5 A:..✓Ltawt <br /> (2a�l;o s s peraor> re el bluer+ Mern'Ax-ren y <br /> w- S-t5- St <br /> Y ) S.ID. 5To9-8' <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 /> _. _.. _._ <br /> If Newly Purchased - <br /> FORD aoo6 bus 1FAFP34M36udt34 97- ; s,r`.'Saa ; iu /in <br /> Peat 9-00 r 'Tay rus J.FAFPSUVSA al-ok37. T /3./tl <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural ❑Educational 401 Religious 111 Charitable ❑Cemetery as indicated? <br /> rid <br /> 11-,i�d�a-�sad <br /> Give detailed description of use,including an a lanation if multiple use classifications exist: [3,}In Cars {['ravelle'oM DYES ❑NO <br /> l�ra�-T,zla�<! is OV!' w(.oxasaeryn2v. IC+a9r s.D• $DtlL cells +rice\ .caAct -Cram, c44ser <br /> S k1cvse5 ;n Mek_as ka . GC911 Cars -+r'ave{ to -&.&o yap y s{dce 4c If No,give percentage of exempt use: <br /> 5t0 td5. `Ike Foe us +ra.velc -o c%sr1 cop,. gies5<d SaccaR,ewf city rck <br /> (SSJm( Clarcce's ipa-.a of vwiv<;sary ) • 1lt€Ta,jrus +ravels 3a and crow, 6rar.«1 <br /> Ce +rat Ca-+CoIrC H- SC(-tad (Ss-bf P)ubara'5 .deco otF 17..on..Cg-i(y). <br /> Ss Clarcce korfjec —Pas+eral IA OA-l54-er a+ 131es eci 5,re',.,e:..tek„ret, • <br /> S cs W eirbara \owal kowsL —C pus- )4;4;5+er/c teelCyy 4ea k.r 0£ra,dSrb.dCe.d.alCa+l,el;r_H9k cline l <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 1 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 j. Cjetik:cp if/`rl / Pas-tic 1 lit;ill.;s+ ac /b /l3 <br /> here ■Authorized Signature Title Date <br /> UNTY TREASURER EA, , ,RRECOMMENDATION <br /> [�]APPROVA R CEl a COM NTS: wy'"'Y" ,.P'u 4-'SS 77— R'O s�J <br /> .20/3 <br /> ❑DISAPPR AL ;s ,I 7 P• <br /> *Aet tCTf1:1Wti;ybl"rti . Signature of County Treasurer Date <br /> crow'.f I i i n -t3`r'ti��sYd'rY =^'PITY BOARD OF EQUALIZATION USE ONLY <br /> ]-APPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> i <br /> • Authoriz=•Signatu ge'' Date V <br /> Nebraska Department of Revenue Authorized by Neb.Rev.StaL§fi 77-202(11(c)and(d),and 60-3,185,and 603,169 <br /> 96-251-2006 Rev.8-2011 Supersedes 96-253-2008 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />