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l'rill nu• P. 002 naIIi <br /> rKA Application for Exemption I FORM 9 rJ <br /> Good ufa.Greetsenrlre. I from Motor Vehicle-razes by Qualifying Nonprofit Organizations <br /> em...,,.,nw. ,•,,, <br /> •To be flied ow with county treasurer. 457 <br /> •Head Instructions on reverse aide. <br /> Name of Organization Type of Ownership <br /> Mosaic ®NOrprorit Corporation ❑Other tenacity): <br /> Name of Owner of Property Co my Name <br /> Mosaic Snnte where Incorporated <br /> Hall NE <br /> Street or Other Meiling Address <br /> Contact Name <br /> 2846 Old Fair Road Phone Number <br /> Gayle Christians <br /> Oily s are 308.381-7 fi90 <br /> Zq Code Email Address <br /> Grand Island <br /> NE 68803 <br /> Identify Officers,Directors,or Partners of the Nonprofit Organization <br /> Title Name,Address,City,Stale,Zip Code <br /> See attached <br /> Description of the Motor Vehicles <br /> -Attach an additional sheet,If necessary. <br /> — <br /> Motor Vehicle Make Model Year DodyType Vehicle ID Number Registration cake or <br /> Date of Acquisition, <br /> See attached If Newly Purcheeed <br /> Exempt flees of Motor Vahlple� — <br /> 0 Agricultural and HortculturalSociety ET Educational ®Religious C as iitnddiicatetl rush des used epyUSrvehy <br /> Chartable D <br /> Give dafaded description of use.including an explanation if multiple use clagypcatbns exist: ®YES 0 NO <br /> for Mosaic client outings, meetings, appointments,shopping,work,etc. 0 <br /> If No,glue percentage of exempt use: <br /> % <br /> Pewees of law,I del thatthave exainned This exempilon applcaton and,to tie best at my knowledge and ballet Ills oorred and complete. <br /> n <br /> I that I am d 'cued n Ihls atempdon application. <br /> sign <br /> here <br /> Administrative Administrative Assistant 11/8/18 <br /> roe Dale <br /> ,!��r,,L((�)) For County Measurer Recommendation <br /> C (�t� ca <br /> J <br /> pp .val }8$a.+.sie.i . J` CO menu: 1 IYf/L IUc.� I 1' �W <br /> Q Ois:•proval <br /> DEC 2016 ► .4 12\1118 <br /> Signature of County Tree rer oats <br /> E+SLL1•®6'N# '•r County Board of Equalization Use Only l <br /> TREASURERS OFFICE J <br /> �� <br /> P GRAND ISLAND NEBRASKA <br /> menu: <br /> ❑Disapproval rp - <br /> •'.ed Signature nak+ <br /> / <br /> Habra*.Department of Revenue �__, <br /> 96-2UaCos net.].ZOIa aWwceaaser+i!a3-yppa iiev.8-2011 <br /> Authorized by Neb.Nee.Nat gg n-IDZ[t)ld and(alp and mates.and 5os,tae <br /> Please retain a copy for your records. <br />