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05/(7/2018 10:25 13083816520 . MOSAIC GI PAGE 02/04 <br /> A. <br /> � -�- <br /> for Exemption A X wA <br /> Neb eDepartment dram tel Vehicle Taxes by Qualifying Nonprofit Org,nizatio !$ �j- Ito i g <br /> REVENUE , .To be bled wile your county treasurer. <br /> ppnp,__t1Y T__- „.,_�„ ■ I .Pest Instructions On reverse aide. ,J _ <br /> Type of Ownership <br /> Applicants Name <br /> Mosaic ? C. my Carpoaflon <br /> Street or Other Malang Address Flail <br /> •2846 Old Fair Road Q Other(roeaN)' <br /> Olty State pp Gods - St»where Inwrpehted .? <br /> Grand Island NE 68803 NE • <br /> IDENTIFY O FIC4RS, DIRECTORS,OR PARTNERS OF THE NONPROF' •ORGANIZATION ;6. <br /> Title Na -:,Address,Cay,Stale.Zip code :'I <br /> li <br /> Linda Timmons CE• <br /> Scott Hoffman CF it • • <br /> . . 7C ' IC a. r • 4 <br /> • . DESCRIPTION OF THE MOTOR VEHICLES'Attach an additional sheet,if necessary. .., <br /> r Registration Oats or <br /> Veh+a ID Number Data of Acquisition, <br /> Motor Vehicle Meta Medg Year HodyType if Newly Purchased <br /> Toyota 2t 18 Rag,I.. 2138E pIIIIIIM IMII <br /> t ` <br /> Exempt Uses of Motor Vehicle: I - Are the moloinshieles used exclusively <br /> as Indiwtel <br /> ❑AgricuautaI/Horticrdtural ❑Edu ;aW I ®Religious ❑Charitable ❑Oe^'+ ry <br /> s A <br /> Give detailed description of use,including an axpl• O <br /> natUllf multiple use classifications exist RYES 0 NO <br /> Transportation of disable individual. i u No,give p4ceofego of e*empn aeu <br /> • <br /> Under penalties of lain I declare t 1 heae examined this application and that It Ls,to the best of my Ioh =•.•-and hers,true,complete,and correct I <br /> also declare that tern duly author'...•toe an this exemption application,and that the organhadan owning• e above4isted property does not discriminate <br /> in me , ip or employment bas-don raw,color,or national origin. <br /> 1 <br /> sign ,”. a,,,l =i. . r _ . ._ A , CR■,::.,4, i ' 5-16-ii <br /> „„e »: <br /> here .R—_� e i J <br /> 1 I FOR COUNTY TREASURER RECOMMENDATION I <br /> • <br /> APPROVAL R C � O MM S: t4 E C" •' . <br /> D DISAPPROVAL , /� �p <br /> MAY 1 7 2018 I. i t __ I 'll ti ..• 1 II .� .. f.-.kA bat5IlItt ) <br /> ,, , ed County T !2•et <br /> • <br /> L 1 FOR COUN BOARD OF EQUALIZATION USE ON Y <br /> HALL 1.. UNIY <br /> • e�., TREASURE•S O'FICE <br /> • pi APPROVAL GRANO ISLAN a,NE SRA 8; <br /> [3 DISAPPROVAL Or 1� � <br /> ea Signature 0 <br /> Nebraska oepenment d serene i• Authorize by Neb.Pa.Slat 4571-2ae(1llal ane(e).and 04,1e5.areevs,fea <br /> S6asa27o6 nett e-nil Sipereeea i e67ss-2e06 ee.c. ••- <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS : <br /> • . <br /> „ <br />