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_.. � _ � <br /> � � Notice of State Tax Lien <br /> ��.�e <br /> � 'oepartment � . <br /> ofrevenue � � .. <br /> � Name of Taxpayar . � � � ' � . <br /> Daryl A. Fisher 7�� U G O s c�3 <br /> Number antl Streel � � � <br /> CI[Y Stale ZIP Catle � . � . . <br /> ' Wood River NE 68883 <br /> Doing BYslness AS Llen SBrlal Number COunty Flletl: Oate <br /> Twin Valley Concrete & Bldg. 8/O1/788 Hall 1/30/78 <br /> Numbei antl 5irset Social Security Number Nebraska Itlentlticatlon No. � � <br /> 209 E. lOth 506-70-3349 21-3182711 <br /> C��1� State Zlp Cotle Llon LIln F��etl At <br /> Wood River NE 68883 � <br /> � �Original ❑Renewal �C Reqister ot Deetls ❑Co.Clerk . � � <br /> Pursuant to the revenue laws of the 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 cons[itute <br /> a lien upon prope�ty in the county belonging to the trxpayer or hereafter acquired. Liens for sales and use taxes only <br /> attach to the re:�property of the taxpayer located within[he counry or hereaCter acquired. <br /> " � INSTRUCTIONS FOR TAX CATEGORY NUMBER AND DATE OESIGNATIONS APPEAR ON THE BACK OF FORM. � � <br /> Tax <br /> � Catpory Tex PeNod Data Dus Amount of Taac Panalty Interart Additions Totsl For �- � . � <br /> Numl»r <br /> Tax Catpory . . . � . <br /> 4-1-77 thru <br /> u 4-30-77 7-31-77 92,09 4.60 2.76 99_45 <br /> 7-1-77 thrn � <br /> 21 9-30-77 0-31-77 201.60 10.08 3.02 214_70 <br /> 10-1-77 thru <br /> 21 12-31-77 1-31-77 246.36 A 9 246�36 <br /> i <br /> TOTAL SC)0.51 � � . � ' <br /> FOR USE OF RECORDING OFFICE � <br /> ! I hereby certify that the Nebraska Department of Revenue has fully complied with <br /> the revenue laws of the State of Nebraska in the determination of the amount <br /> shown to be due,and the ta�cpayer has Cailed to pay the amount due after demand. <br /> If this Notice of State Tax Lien is an extension of an effective lien it serves to <br /> continue the priority of the state's interest in the affected property of the taxpayer. <br /> Dated this 2JtIi day of January 19 7g <br /> � � sign�� �-- - � � <br /> __' �e/�,Aut�orize Ign urs � <br /> � Sianager <br /> Titla <br /> '-:i <br /> ja.a9aaa rx.v.ii-»suaersea.s a-asa-�a Ra�.ias ., .� <br /> ����.STATE TAX�COMMISSIONER—Whits antl Canary Copies . TAXPAYER—Vink Copy COUNTY OFF�CE—Goltlenrotl Copy � � ';� <br /> .., <br /> ��k` ., . .... '.._. � . . ' � .. . I ��: .. �y�i <br /> ...,..,_ .. . .. .. J . <br /> L _ <br /> � : <br /> ..�-:-. <br /> m , , .� . <br /> _� <br /> � � <br /> k <br />