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\ <br /> ��� <br /> �� \ � C.O C� CI'� <br /> � � � --� <br /> � D� <br /> � �� � � � � � rn � � <br /> .\, <br /> 7 � { `< F� c.-�D <br /> f ' � , N r.a -� � '` <br /> �v � � � �� � � '� � T ` '�-+ fl" <br /> \� �( �� �.r C � ���� .; `.'' �, <br /> 1� `�, � cr o <br /> � '' � J � c :; �� � � � -� � <br /> <,� � � <br /> �� �S ��� � �� 1-�-+ � c <br /> � (� A � <br /> p1� `'` � � � � � CD <br /> �''1 C1� .�-+- <br /> � <br /> O <br /> �' Notice of State Tax Lien <br /> �Ir <br /> � � � <br /> � � <br /> �� <br /> PLEASE DO NOT WRITE IN THIS SPACE \� <br /> This Notice of State Tax Lea is issued by the Nebraska Department of <br /> \ <br /> Revenue for unpaid taxes pu�suant to the revenue Iaws of the state of <br /> Nebraska. Notice is 6ereby given that taxes including penalties and <br /> lnterest, which sre shown below, are dne tbm the taxpayer specitied <br /> below and r�main anpaid aRer demand. These taxes consNtute a lien in <br /> We rnunty for resl and personal prnperty belonging to t6e taxpayer or <br /> heresfter acquired. <br /> Nebraska Idendflcation Number Lien Filed Wrth Sodal Secxirily a Federal I.D.Number Spouse's SoCial SecurUy Number <br /> 3946775 R�a°«°s Q�°�nyG� 508-48-2383 <br /> LJer►Seriel Number Lien TYPe Date of Uen Cp�y <br /> 980100214 °"�"� ❑°on��" ❑��� 5-11-98 IiALL <br /> BUSINESS NAME AND LOCATiON ADDRESS TAXPAYER NAME AND MAILIN(i ADDRESS <br /> 3usiness Name �� <br /> A JANIS GUSTAFSON <br /> Street Address Street a Olher MaiNng Addresa <br /> PO BO A <br /> �Y S1ate Zp Code City State Zip Code <br /> IP <br /> � Date of Balancs of <br /> Catpo ry Tan Perlod � AmouM of Tax Panalty Ints�t AddRlons �Dw <br /> NumbK <br /> Ol—01-86— <br /> 22 12-31-86 11-24-9 717 25 17 31 1 1 <br /> 01-01-87— <br /> 22 <br /> 01-01-88— <br /> 22 12-31-8 <br /> 22 Ol—01-89— <br /> O1—01-90— <br /> 22 12-31-90 11-24-9 897.00 224. 25 612 3 1733 59 <br /> O1—01-91— <br /> 22 12-31-93 11-24-9 2241 00 560 25 1 00 7 3 1 8 <br /> TOTAL $ 22 1 <br /> I hereby oertify ttiat the Nebraska DepartrneM of Reverwe has complied with the revenue laws of the State of Nebraska in the determination <br /> of Cre amourrt shovm to be due,and the taxpayer has failed to pay the amou�t due after demand. if this Notioe of S'tate Tax Lien is an e�ctension of <br /> an e(fecc�vve lien,k serves to oontlnue the priority of the state's iMerest fn the affected property of the taxpayer. <br /> sign �- � � �� <br /> her �� e - _�„up `�. �,,�-�- G «�s�-s�=��-v <br /> �8l TelepFane No. <br /> �--� /.�s i �Si/ � <br /> a,a�o�z e r,ne 8 <br /> � NEBRASiCA DEPARTMENT OF REVENUE-White and Goldenrod Copies TAXPAYER-Pink Copy COUNTY OFFICE-Canary Copy <br /> ����°� �-asa-�s aev.�aes supe�.sd..a�aa�-�4 qev.s-es <br />