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Application for Exemption FORM <br /> I.UE 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 /> SERVANTS OF MARY SR RITA KOLBET ®Nonprofit <br /> Street or Other Mailing Address (` r �f County Corporation <br /> S2 1 )-'c .S'fohe L(JOOd 4V Q HALL ❑Other(specfy): <br /> City State Lip Code State Where Incorporated <br /> GRAND ISLAND NE 68803 NE <br /> ,�,f IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OFTHE NONPROFIT ORGANIZATION <br /> Title('!h en�,C•.r l /✓ rs,A r- Name,Address.City,State,Zip Code <br /> CI—.Mail &ellr ;n eh 7weeM ; l140FCC lot 0),,,,_Ara- A/C 6.A/34e <br /> 5 <br /> - r <br /> St. Mgt�afetbi•-a-trlax � yya�,>,1 %I do �UQ lint qua ,U�� 3v <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet,if necessary. <br /> Registration Date or <br /> Motor Vehicle Make Model Year Bo•yType Vehicle ID Number D ate of fy Acquisition, <br /> otl <br /> FOrfl I U'71ote 7 ,-7 r -oo • FOeus z ti 1 FA FP3YN7cu i o3o Es/ <br /> ' <br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively <br /> ❑Agricultura&Horticulturai ❑Educational Religious ❑Charitable ❑Cemetery as indicated? <br /> Give detailed description of use,including an explanation It multiple use classifications exist 1�I YES ❑NO <br /> /� 1 /� / If No,give percentage of exempt use: <br /> earl; 7Io4 5 kit i S7fh.� a4 U)eleL�Pci t'�' % <br /> f;u, yes <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 /> i 6- - 1 <br /> here .d. r_slolna <br /> Nithodzed Signature ills Date <br /> FOR COUNTY TREASURER RECOMMENDATION I <br /> e- APPROVA RECEIVED COMM1NTS: G se14, t ,a 4;01, '4‘77 o <br /> ❑DISAPPR• AL <br /> MAY 1 3 2014 .A" .� . / ry <br /> Signet County Treasurer Date <br /> HALL COUNTY • - COU i BOARD OF EQUALIZATION USE ONLY 1 <br /> ���{{{...,,, GRAND ISLAND NEBRASKA <br /> ly APPROVAL COMMENTS: <br /> ,o DISAPPROVAL <br /> rya /16 cam o/ f <br /> ►Authorized Signahae _. <br /> Nebraska Department of Beanie Authorized by Neb.Rev.Stat§§77.202(1Xc)and(N,and 60-3.105.and 60-3,189 <br /> 96.253-2006 Rev.6-2011 Supersedes 96-2512006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />