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<br /> . � Notice of State Tax Lien ��---��—
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<br /> wr�inw PLEASE DO NOT WRITE IN T}11S SPACE ;�,��';�
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<br /> ,...., INDIVIDUAL INCOME TAX �y �-
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<br /> ��i SOC. SEC. N0. 508884688
<br /> ` NEBR. IDENT• N0. 34637�1T8
<br /> � � SPOUSE S�C• SEG• No. lqq3
<br /> ��� TAXABLE YEAR 971640186
<br /> LIEN N0. s�—°"—
<br /> � COUNTY HALL SHAWN T ROARJ[GUE2
<br />� , �� DATE LiF NOTICE 06/13/9T PO HOX 43 _
<br /> d DATE OF ASSESSMENT ��a"`�� A�A NE 68�10
<br /> :+;
<br /> � THIS NOTIGE OF STAT� TAX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF
<br /> itEVENUE FOR INDIVIDUAL INCGME TAX PURSUANT TO THE REYENUE LAMS OF THE
<br /> STATE OF NEBRASKA. NOTICE IS HEREBY GIVEN THAT INDIYIDUAL INCOME
<br /> TAXES INCLUDING PENALTIES AND 1vEEANpTREMAINHUNPAIDHAFTEREDEMANDE DUE
<br /> FROM TIiE TAXPAYER SPECIFIED AB�
<br /> ' THESE T/IXES CONSTITUTE A LIEN IN THE COUN7Y FOR PRQPERTV BELONGING TO
<br /> _,'� ``�� TNE TAKPAYER OR HEREAFTER ACQUIRED•
<br /> � AM�UNT OF TAX � • • • � • • • • • • • • • • • • � 622•00
<br /> PE NALT1f • • • • • • • • • • • • • � • • • • • • • 168•28 -
<br /> r� INTEREST (CONPUTED TO 06/13/97� • • • � • ' • • '
<br /> 70TAL AMOUNT DUE • � • + • • • • + � � • • • � • 8210$8
<br /> I MEREBY CERTIFY THAT THE NEBRASKA DEPARTNENT GF REVENUE HAS COMPLIED =
<br /> MITH 7NE REVENUE LAMS �F THE STATE �F NE6RASKA IN THE DETERMINATIGN OF _��^�
<br /> � YHE AMOUMT SHOMN TO BE DUE� AND THE TAXPAYER HAS FAILED TO PAY THE �;����e�:
<br /> � AMOUNT DUE AFTER DEMAND. IF THYS NOTICE �F STATE TAX LIEN IS AN _ _ ��'
<br /> �; EXTENSION OF AN EFFECTIYE LIEN IT SERYES TO CONTZNUE TN� PRIORITY OF .--=—��w
<br /> THE STATE�S INTERE57 IN THE AFFEC7ED PR�PERTY OF THE�AXPAYER•r3� � a �,��_
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<br /> •• •••• • • • DATE
<br /> AUTHORIIED SI ATURE tITLE T�PA�R�p�k�y courirv—c;oaenrodcopy
<br /> ------ NEBRASFU DHPARTMENT OF REVENUE—VY�fta end Cenary Copies �•��s�ri.+-+aas s�+o���•us7°a.v s•9�
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