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.070/1/ <br /> Application for Exemption FORM <br /> _ fiUE from Motor Vehicle Taxes by Qualifying Nonprofit Organizations 457 <br /> 'To be filed with your county treasurer. <br /> al •Read Instructions on reverse side. <br /> Applicant's Name Type of Ownership <br /> SERVANTS OF MARY SR RITA KOLBET ®Nonprofit <br /> et or Other Mailing Address I 'County Corporation <br /> b �— S 1031E 0004 V Q HALL ❑Other(specify): <br /> City State Ip Code Slate Where Incorporated <br /> GRAND ISLAND NE 68803 • NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title r.A to NCr.CI J✓I A/1 e-snhQ 1^ Name,Address,City,State,Zip Code <br /> ck...4.4011 (.2ehiringei- 71,00A ; 1r '1a"/ 1 u 0»1aha- A/C b i34' <br /> Ss, AMar�ai-etS"1rbtman s7yao,G1 ;1110/- t IvQ l)m46A leae/34y <br /> DESCRIPTION OFTHE 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 /> Ford I21t Info 7.a-'r - Ot-us zxq - -1FA-fP341A/7fss-o3o5N <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑AgriculturaVHorticultural El Educational I Religious El Charitable El Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: f.71 YES ❑NO <br /> Ake{ }/ / J If No,give percentage of exempt use: <br /> 4111¢-4 r l O et 5 S / / Lta d �el a l e Gr �I ye 7; % <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 em 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 /> / <br /> 5 2( <br /> sign ...... �_lta. �_�. .1 e A.A. <br /> / <br /> here. Authorized Signature isle Date <br /> FOR COUNTY TREASURER RECOMMENDATION I <br /> PPROVA RECEIVED COMM NTS: 4 ce''ry7 t 14W ,v,$14. 11 77— �c'7 <br /> ❑DISAPPR• AL <br /> , MAY 1 3 2014 � ..,--di,-el c�".y -may <br /> Signat County Treasurer Dale <br /> HALL COUNT? p•• COO I BOARD OF EQUALIZATION USE ONLY <br /> .{, GRAND ISLAND NEBRAS <br /> AAPPROVAL COMMENTS: <br /> ❑DISAPPROVAL <br /> Authorized Signature e <br /> braska Depariment of Revenue Authorized by Net..Rev.Stat.55 7r-202(1)(c)and(d).and 60.0,195.and 60-3.189 <br /> • <br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />