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:�� <br />:';::.� , . <br /> `� � y» <br /> t ._:, <br /> i � � � � <br /> 4�� <br />,�� <br />�� <br />� <br />�`�`'� <br />. , <br /> . <br /> (— __ ...- .._.__.._.._,___,_. ... ___ _.– ...._. . .___ . _._.... . _ _,. ._ _. . , ._. . . <br />� � i <br /> , 76- 005941 <br /> � P�b��ka Notice of State Tax Lien <br /> , � 1aepartmem . . <br /> IDffCVEnuC <br /> . � � Name oi TaxDayer � � . � � <br /> :iae�3r ::ubrec* <br /> � Number ana Street . . <br /> P.t` :inx 2;.Fi <br /> , CItY State ZiP Cotle . �• � <br /> � . � ::�.iit! .._ i;�:l�(1 . <br /> � Doing 6ustness As . � � Lien Se,ria�Number County FiicC: Uzte <br /> � 1.Ic?� ,—"tf? f>tttttc:a�d i,jli?i3fi�R al.i 1:��/72/7E � <br /> Num6er antl Street � � SoGial Secur{ty Num�er NPbraska ItlentNication No. <br /> 1;1:ia =r.t!?rC:�r:::^.n. n:. I—�iG 46:'->','j..�'�ii." �77,::�92 <br /> � �{�y. State l.ip Cuae �ien , Llen FIicA Al <br /> . . . . `ijt�1S ..;Y- � . `'r�:��t �Ori9inal U Renewal {� ReAlster of Daetls u Co.Clerk <br /> Hirsuant to thc revenue laws of the State of 1�`ehraska,notice is hereby civen tl�at tazes(including pcnatiics,interest,and <br /> - additions)have been asse�ed�nd are due from the above t2cpa�•er and remain unpaid after demand.These taxes a�tutitutc <br /> a lien upon property in die county bclonging to thc taspayer or hereatter acquired.Licns for sales and use taacs unly <br /> �ttach to thc real property of ihc taapayer locatcd within tlie cnunty on c�reafter a�quired. <br /> INSTRUCTIONS FOR TAX CAiEGORY NUMBER AND DATE DESIGNATIONS APPEAR ON THE OACK OF FORM. � <br /> � Tax� 7ota1 For <br /> Gtegory Tat Period Oste Due Amount of Tax Panalty �Interest Additions Tax Cateqory <br /> Numbe� <br /> ti—�'1Z—�(i ,r.�tTi2 � <br /> Qi �3r�..7i: ?—?1—?E, I �`i,44 ��;, I � so t t._^. ��y <br /> � <br /> � � <br /> i <br /> � I <br /> 1 <br /> I <br /> I <br /> � <br /> TOTAL <br /> FOR USE OF RECORDING OFFICE <br /> 1 hcrcby ccrtif�•ihat 1hc Nebraska pcpartment ot Rcvcnue has tiilly:omplird wiUi <br />� �� the rerenue ISNS o[thr State of Nebraska i�i thc dctemiination of�hc amount <br /> diown tu be dne,and the taspal�er h�failed to p�y the amount duc aficr demand. <br /> If this,Notice oP Sc�te Tax Licu is an extension uf an cllecti�c lien it sen�cs tu <br /> cun�inue ti�priority of ihe sta�c's interest in the affecicd propert}•of the ta�parcr. <br /> � <br /> •V Dated tliis �7[r, �3�.i�f ,..Cohr:: ,ly_ I <br />:���,, � <br />��: sign j -___ - � <br /> y-}�t^. ���p�AuthorizeaSlana[u� � <br />�; 6 _ acnm: �£o.cu.�r,. :)f Y:ci:r <br />�`.�5%r,�. ' ru,e, <br /> r�� � <br />'�'�� ..�- �N i <br />���y�� �. G-S?d-7�1 Rev.]�75 <br />�S k! � <br />��y? j STATE TAX COMMI�SIONER—�m�te anC Canary Copies TAXPAYER—�ink Cepy CCUhTV OFF�C[—Golacnrua Cr,ov (� <br />�-'-r" i. <br />``� . . . .. . .... .. . . � . <br />',5"k <br /> .� <br />?y�.f <br /> ��_$ �,�� � J <br /> l� <br /> e <br /> i <br /> � <br /> 1 <br /> i <br />