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<br /> eien-----e__- 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 /> •Read instructions on reverse side.
<br /> Applicants Name Type of Ownership
<br /> SISTERS OF THE HUMILITY OF MARY ®Nonprofit
<br /> Street or Other Mailing Address County Corporation
<br /> 720 STONEWOOD AVE HALL Other
<br /> ❑ (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 /> �e5'ter Je•on +ob:,ti Lark �e.si<P..nt eagle SIT biergrtcn gj- )'Ila an`'a, PA /6 %5'.5
<br /> DESCRIPTION OF THE MOTOR VEHICLES
<br /> •Attach an additional sheet,if necessary.
<br /> Motor Vehicle Make I Model Year Body
<br /> Registration Date or
<br /> rype Vehicle ID Number Date of Acquisition,
<br /> if Newly Purchased
<br /> TOYOTA 2013 4 DOOR SEDAN 2T1 BU4EE2DC956656
<br /> Exempt Uses of Motor Vehicle: j1 Are the motor vehicles used exclusively
<br /> ❑Agricultural/Horticultural 0 Educational IN Religious DWl Charitable El Cemetery as Indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications wrist: / ,,r I + OYES ❑NO
<br /> Crse. c r iS h&c 4 r [Peg+Oral tAev sf,Y--y( JL$r+ n, 1-k.L srck 4- aottrfl/
<br /> pre,w:oe;no •1-kt CoA-9 olA-ty�d+v Of +i.e g+*�Itartset V-bo +Iv.e-.-v i.K. 414.4-ir {w,�.Lg If No,give percentage of exempt use:
<br /> he5$;t•.-ie `F orl,.cr V�5+;-1-.<'d-ioa5r -Por cm.•-dnnt-e.- ell re+Icr ad-j. �,
<br /> in, L.,4.(.'I ice( Serv.`c cs , "Pe r Q.L(pprY ea:.er k .f 5 tlasSCS +p8✓•-as .
<br /> ae na a15o0 'Pot ?r cekot^'�'5¢¢'' *" nce-#t Clal ter s' -S ryµ;r i'nq a aDLA.Ly�
<br /> -Nip p<. ,�,,,,Aier, cprvnse.lr`.5 , 'trA..s ref:at ter
<br /> c�fL. G tl {
<br /> Under penalties of law,I declare that I have examined this application and that it ie,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 properly does not discriminate
<br /> in membership or employment based on race,color,or national origin.
<br /> sign /�•
<br /> / -,_.� _ ' ' .M. -C -(/ 4 Daps It/6
<br /> here • zed Signature - , Title
<br /> Date
<br />• Y FOR COUNTY TREASURER RECOMMENDATIO NN
<br />• APPROVAL RECE! EOOMMENTs: "6RE41
<br /> reL `
<br /> "�v/845, Sr 77ya.o<2-.
<br /> ❑DISAPPROVP..
<br /> DEC .'.
<br />•
<br /> L y al
<br /> Signet re of C unty Treasurer Dale
<br /> HALL COUNTY
<br /> TREASURERS OFI@ff COUNTY BOARD OF EQUALIZATION USE ONLY
<br /> GRAND ISLAND,Nebnaoua
<br /> ❑APPROVAL • COMMENTS:
<br /> ❑DISAPPROVAL
<br /> -, _ ems- _._/-,_ � //o 19
<br /> Authorize; gnaw Dale
<br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c)end(d),and 803,185,and 60-3,189
<br /> 96-253-2006 Rev.8-2011 Supersedes 96-253-2006 Rev.5-2009
<br /> PLEASE RETAIN A COPY FOR YOUR RECORDS.
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