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• <br /> d 11/• <br />• :�rt:-z Application for Exemption FO M <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 /> SISTERS OF THE HUMILITY OF MARY ®Nonprofit <br /> Street or Other Mailing Address County Corporation <br /> 23 O E-ANS BR 7 nn L Ave_ ALL <br /> 0.Q St rle t,�dA t1 ❑Other(specify): <br /> City State Zip Code Stale Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Title p Name,Address,City,State,Zip Code D <br /> cur e' 1 .. _'ra`i Tr i, ± PO G . Si g cr reen foe• ' it l : la ✓i 5:5 <br />• <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> 'Attach an additional sheet,if necessary. _ <br /> Registration Date or <br /> Motor Vehicle Make Model Year Botly Type Vehicle lD Number Date of Acquisition, <br /> �l if Newly Purchased <br /> 14py.otet 2,ao7 4f Doar Se- an 1 AGFq/63-271-13530 <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultural/Horticultural ig Educational ® ,Religious Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation it multiple use classifications exist: / ®YES ❑NO <br /> A�ife a w. ;o it. Fes- ¢_ <br /> �IC d„ �u i If No,give percentage of exempt use: <br /> - ,/4.+--..w'Dey N^�~�r� / ',',"!j^yJ('"�,q(4Q.-. A-e1..o...+-.3 e ��^�1 q <br /> r a,.. / '` • Y Va"...."4- 1111"."...r-`yJ" ctv�•�'C*-C..,, , Le. <br /> ins?, C---•-..-a4.47. f+0---°,�i- 1+4-s(l .c-v. V <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 %-'.L AI L").0 dm. � P ' �r� a/lzjzal3 <br /> here I Authorized Signature Title Date <br /> FQ -^Co ID TY TREASURER RECOMMENDATION <br /> APPROVAL RECEIVED MMEN-S: L'r,., - io,•4 4..r"-�.. ''%%°,4'C 2 .. <br /> ❑DISAPPROVA_ DEC 1 6 2013 <br /> er �. J_, /--c - // <br /> HALL COUNTY Signature of <br /> .,„fir <br /> o my Treasurer Date <br /> TRCACURCRS ormir <br /> 1 - GRAND ISLAND,NE COUNTY BOARD OF EQUALIZATION USE ONLY <br /> 1c APPROVAL COMMENTS: <br /> YYY❑"'DISAPPROVAL <br /> Authorized Signature /ale <br /> Nebraska Department of Revenue Authorized by Nab,Rev.Stet.§§77-202(1$c)and(d),and 60-3,185,and 603,169 <br /> 96-253-2006 Rev.a-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />