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9-4) 5 <br /> ....„..,-- 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 /> Q: •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 OFTHE NONPROFIT ORGANIZATION <br /> Title Name,Address,City,State,Zip Code <br /> Prioress Si Ste r Penny rgka.M <br /> £RP�i3ious StipCnc) Sae red Neart as+er3 <br /> I&Y5 IA), St`- S+. <br /> yaukrot.tf s,D. 57o7t <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> *Attach an additional sheet if necessary. <br /> Ristration• <br /> Motor Vehicle Make I Model Year BodyType I Vehicle ID Number ( Date of Acquisition, <br /> if Newly Purchased <br /> Fokt ataab <br /> FOCUS 1F1FP3`IN3IoW1G34z7- NErejifratfon <br /> I S50 C <br /> 1ofyf Io <br /> Exempt Uses of Motor Vehicle: p Are the motor vehicles used exclusively <br /> ❑AgriculturaWlomcultural ❑Educational cif Religious ❑Charitable ❑Cemetery as indicated?• <br /> Give detailed description of use,including an explanation if multiple use classifications exist'Tine ticks-c I e I S used for WITS ONO <br /> tt'a ,sOcct'a-hion -Frown PIA u koOne_ -k it,y Place 04- At;x•t5}r u, C Blessed <br /> $act{ainc..t Chv cctl) a,&J. drivt -fcc 5a;4 m.x..a+r3. Tine veln,ele ; S ako II No,give percentage of exempt use: <br /> VSed +o accve -to SacctA 4teart a+erti for relisccus ,.1ee1 ..95, T.A. add7+ron % <br /> to 4A, +\-c ve kcal e ;5 AC;Vey. to O••+atna, 1—1%Cela 13•A2' keacPt e�S 'Co( <br /> y..n a etc-,qls w;tti oaer s;sMe is -Qrom Sac red ft err hicmastar5. <br /> Sssker glance forger- ?5s4arat M'"'`s-I-era+ Blessed.t'rakne,,.t ch 'ce lvt <br /> 305s— 384- 053D- €xf• ace <br /> Under penalties of law,I declare that I have examined this application and that a is,to the best of my knowledge and belief,true,complete,and correct.I <br /> also declare that I am duty 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 a• e.F;wlLc.v u8,-- l-,✓ Pas�rzi /4 csf er lk /l to /Hi <br /> here I Authorized Signature t7 Tine Date <br /> r - •r UNTYTREASURER RECOMMENDATION <br /> W,�, ,�// R I ":"--12"11,11-' �S..S, 'it 7'•_ 2.0.e <br /> LlyRYPROVA • ' 1 COMM:NTS: �p�'J <br /> ❑DISAPPR. AL NOV 1 8 2014. <br /> courtier It Signature u yTreasurer Date <br /> . c,ci.SP OU , BOARD OF EQUALIZATION USE ONLY <br /> PPROVAL COMMENTS: <br /> ❑DISAPPROVAL m id / ILIA /— 13-/5 <br /> .SPorized Sig =t rilar ve. Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stet g§7/-202(1)(x)and(d),and 503.1 M.and 511.3,159 <br /> 96-253-2005 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />