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affil et^=---a., Application for Exemption FORM Nebraska Department of REVENUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 •To be filed with your county treasurer. •Read instructions on reverse side. illApplicanft Name Type of Ownership BF$IEDICTINESISTERS BENEDICTINE SISTERS ®Nonprofit Street or Other Mailing Address County Corporation 2939 PINNACLE POINTE DR HALL ❑Other(specify): City State Zip Code State Where Incorporated GRAND ISLAND NE 68803 NE IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION Name,Address,City,State,Zip Code Title � Y. P roc e55 Si54 -r Pet B;Inskawt (R4 nvs Superior) Sacred Hceri- Movkisi er9 I WS ttif , 8}" St . Ya...kt-on l S P, 5"enle DESCRIPTION OF THE MOTOR VEHICLES •Attach an additional sheet,if necessary. - - - -- _ -- -- - Registration Date or Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition, _ it Newly Purchased FORD 200 to FOCUS 1FAE P211N36(4 t-3ya 3- NE r.j;s}ra+i 01‘ I sSUe a _ IO / 4 Ac Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively ❑AgriculturavHorticultural ❑Educational k2, Religious ❑Charitable 1 ❑Cemetery as indicated? rry Give detailed description of use,including an explanation it multiple use class icalions existrik ve L i C IC ;S Jsec YES ❑NO cec kThs tt^Fiev, 4`rcw- yy Naw.0 tr. w. !ta 0H ni54-e %Blessed Sacra n..e.-t ('a t•c ct.�l^) avid dri,r:.v,3O'er s4i4 r.+;..rslry. The velure le rs also vsed to drive to (-4 ear+/u(alias+ery 4r ft U.5rc'v5 Wl teli,w5S.Ike Vekrcie t;.. arid;{ion f-a being.l-.y CR If No,give percentage of exempt use: Sa fi t yfeJ5 I\ e{i 5 at- Sacred II-ear} )4C!Masr+�ery, Isdr;ve:t +o Cstsakal lint of riy i via V.edrne`5 c - „,C ;455 w ;4k o-il4er 5,5 5 i*cn‘ 5acrccl atart 14evu,s-kxie S;51ecCtarice \agar— Pas-kc at M.vxisl A- a-c- Blessed Sacra w.e.,.-t 0L.rrek 306- 38th - OS3a E A• aoa 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 also declare that I am duly authorized to sign this exemption application,and that the organization owning the above-listed property does not discriminate in membership or employment based on race,color,or national origin. here d• r y Yet.✓ Pas-Fora\ M;h ■gie r to/3/l3 Sere 'Authorized Signature ' '°'4 Title Date FOR COUNTY TREASURER RECOMMENDATION APPROVAL RECEIVED,MENTS L/�f'n9a �� 't<4 ' 77 . ❑DISAPPROVAL DEC 5 2013 (....Q!,.114-.47,---"-A'-'--- i --"v FI/U 1 eAU r Signature of Ccifity Treasurer Date TREASURERS QRN.��JJNTY 30ARD OF EQUALIZATION USE ONLY (AMC I;LAND,NI- — 4APPROVAL COMMENTS: ❑DISAPPROVAL • I►i /rti`r �----- /-/ d0/11 Authorized Signature Dale Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)and(dl,and 60-3,185.and 603,189 96-253-2006 Rev,6-2011 Supersedes 96-253-2006 Rev.5-2009 PLEASE RETAIN A COPY FOR YOUR RECORDS.