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Wi=t 7.
<br /> Application for Exemption FORM
<br /> Good of••reatS ry ce I from Motor Vehicle Taxes by Qualifying Nonprofit Organizations
<br /> Oft •To be filed with your county treasurer. /�C 7
<br /> •Read instructions on reverse side. I TJ
<br /> Name of Organization Type of Ownership
<br /> SISTERS OF THE HUMILITY OF MARY %Nonprofit Corporation 0 Other(specify):
<br /> Name of Owner of Property County Name State Where Incorporated
<br /> HALL NE
<br /> Street or Other Mailing Address Contact Name Phone Number
<br /> 720 STONEWOOD AVE 5, &.role e3ake4;&I8m 30g-- 1$-1312
<br /> City State Zip Code Email Address
<br /> GRAND ISLAND NE 68803 CNCnL
<br /> Identify Officers,Directors,or Partners of the Nonprofit Organization
<br /> Title Name.Address,City,State.Zip Code
<br /> #ire..ideh1- Sister .lean Tobin Lcrdie. Pt&& 313 Evert-green ({,P. LUlL4 Mart'__ PA
<br /> ii. 155
<br /> I
<br /> Description of the Motor Vehicles
<br /> •Attach an additional sheet,if necessary.
<br /> I Registration Date or
<br /> Motor Vehicle Make Model Year Body Type Vehicle ID Number Date of Acquisition,
<br /> y if Newly Purchased
<br /> leypta Coecit& 2.0 )3 9 .poor cscia 21.'1B a4C l3
<br /> D_Ct -
<br /> I
<br /> Exempt Uses of Motor Vehicle: Are the motor vehicles used exclusively
<br /> III Agricultural and Horticultural Society %Educational 1,4 Religious %Charitable [j Cemetery as indicated?
<br /> Give detailed description of use,including an explanation if multiple use classifications exist: � > YES LINO
<br /> nit cat- is "5 col' -Cvr Pas+ora( Ninis-kry: I)iset1a�/y Me s cl< i-elelerfy,
<br /> pr0yi[iiH -4 . LGnsola.4tor, vF +ltt eH.fAa•-c!-c4- TD MAed- ft•. `4c sr If No,give percentage of exempt use:
<br /> thanes, tint ittl s 4- bi-Inx,r Tyr s4- ftt4-ii cuts ; -rn- Coi.d,z.n-f + pa.--F:ct_
<br /> pa+id.. L.;4-Nrq C4' SLrLnce,1 `
<br /> J Jqt 1 i -Par �C� evub �4. -t`On e�4.yJ;g
<br /> 3 C.01..4.5 3 ralsoo ,0,1^ 11 l!tn���C.cl't':a.q d'"�.e ry,{ g p� .�,y_t-4.Ct3 -r.Lq t...:h-'se.
<br /> RA✓o ,tc �D2 S kith Cf/HIN44tY , t r„.:(2,I -3, V
<br /> y/ Mw4 f'P/11 cit.
<br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete.
<br /> I also declare that I am duly authorized to sign this exemption application.
<br /> sign
<br /> �,.An Lp...-� c7,f,1i.�.,,QU Am. Qaa$Ore l M;).-;s'fe r /2/i3% uts'
<br /> here Au onzed Signature G' Title Date
<br /> &� t� For County Treasurer Reeccom�mme,,nndatiio{n �l '�h�'t
<br /> l2pproval C 3V @omment: ✓ceM$) IVSSA- 11-aba
<br /> ❑ Disapproval
<br /> DEC 1 3 ;_sus i s . A . �" - D' ► i 1....t: all 3Il ge
<br /> Signature of C.11 my Treasurer Date
<br /> HALL COUNTY For County Board of Equalization Use Only
<br /> 1 Hh•15JHt_i'.a OrFier -
<br /> GRAND ISLAND,NEBRASKA
<br /> Approval Comments: ////
<br /> ❑Disapproval ,„ /, , ,,,,, ,
<br /> ........_...........4, . __ , .
<br /> Authorize.Signatu= "
<br /> Nebraska Department 01 Revenue Authorized by Neb.Rev.Stat.§§77-202(1)(c1 add(d),and 641185,and 60-3.189
<br /> 96-253.2006 Rev-7-201a Supersedes 96-253-2006 Rev.8-2011
<br /> Please retain a copy for your records.
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