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<br /> depanme�:.�� .t�10�'��� Nofice of� State Tax lien � � �� �
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<br /> � of revenue . �
<br /> Name ot Taxpayer � . � � � �
<br /> ;� i.�=ry r�Qa.a
<br /> � NumOer antl Street � � .
<br /> 2416 4!ar�t }.ne Strect
<br /> City � . � State Z(P Catlu �
<br /> �rand i ,t �� Gg�,01
<br /> � Ooing Businasi As Llen Serial Num�er Counry Filotl: Date �
<br /> r� 6 lI 3G4 iva?1 aI/Cai/76
<br /> �- Number antl Straet Social Securlty Num�er Neprazka Itlentlflcatlon No.
<br /> acv ' � . tr..� ' �siace� 5+15..�•>_�, �; ?f 51477i
<br /> _ Zip Cotle Lien � Llen Flletl At
<br /> . �"r � �n � � ?��' jlt{f;()1 l�Orlginal �Renewal Q.Re9lster o/Deetls ❑Co.Ck�k
<br /> Pursusnt to the reve ae 3aws of tf�e State of Nebraska,notice is hereby given that taxes(including penalties,interest,and
<br /> additions)have been assessed and are due from the above taxpayer and remain unpaid after demand.These taxes constitute
<br /> , a lien upon property in the county belonging to the taxpaycr or hereafter acquired.licns tor sales and use taxes only
<br /> attach to the real property of the t:ucpayer located within the county or hereafter acyuired.
<br /> INSTRUCTIONS POR TAX CATEGORY NUMBER AND DATE DESIGNATIONS APPEAR ON THE BACK OF FORM.
<br /> Taz
<br /> . Category Taz Period Date Due Amount of Tex Penalry Inte�est Additions Total For
<br /> Number Tax Category
<br /> 1-1-7G thru
<br /> %�1 — F� i�..�f1_7� ll7 17 �.90 4.13 12i1.D'J
<br />, 1
<br /> TOTAL
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<br /> : FOR USE OF RECORDING OFFICE
<br /> I hereby cerlify that the Nebraska Department of Revenue has fully complied with
<br /> dte revenue laws of the State of Nebrdska in dic deternuna�ion oF thc amount
<br />��' shown to be due,and U�e t:�epayer h;u Failed to pay the amount due after detnand.
<br /> Entered on numerical I
<br /> index and recorded on
<br /> f�this Notice o(State"fax Lien is an exlension of an effective lien it scrves Io /�
<br /> conlinue the priority of�he state's interest in tlie�ftected property of thr tarpayer. ""`� �'?• 1��I
<br /> at ', ,�P:L��s ir._;rcr;.ent
<br /> D�tedthis let �a�.of :iove�-her ,197r, ,
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<br />�- �Aulhorized 519natura ,
<br /> vR;.� �efe ;:ev�nue ?in£orceaent Offi,cer Hafi County, Nebraska
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<br /> Title
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<br />'�'�"� � a-a�a-�a nev.i-�s � 9
<br />.r`�- STATE TAX COMMi5510NER—Wlitte antl Canary Coples TAXPAVER—Pink Copy COUNTY OFFICE—Goltlenroa Copy a �
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