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� �. <br /> nebraska Notice of� Stete Tax �Lien� <br /> � ��e.t��t <br /> or.avenoe <br /> name o1 Taxpardr RObert A. 8/or Ruth Theisen <br /> d u band and wife 7H-- �Q 1$8 9 <br /> �vumberana�straet � � . . <br /> 25T1 West Phoenix <br /> CI[y� � � Statq � Zip COCe � . <br /> Grand Ts3and NE 688U1 <br /> Doing BuYlness Az � � � � � �Llen 5erial Number County Fllea�: Date ' � � � � <br /> s/os/os3 �ii s/�1/�s <br /> Numbar antl StFeat � Social$eCurltY NLmbqr� Nepraska ttlentlflGtlon No. � - .� . <br /> 507-30-0740 17459966 <br /> ccfy � state z+u coae� ue� ��ian triea ae � � �� � <br /> � Original ❑Renewal �Register of DeeEs [�Co_C�e�k . � <br /> Pursuant to the revenue laws of the State of Nebraska, notice is heeeby gi�en Ytiat 4axes(i�cluding penalties,inierest,and <br /> addltions) have been assessed and are due [rom the above taxpayer and remain unpaid after dem�nd.These taxes conscitute <br /> a lien upon property in the county 6elonging to the taxpayer on c�reaRer acquired.Liens for saJes and use taxes only <br /> attach to the real properiy of the taacpayer located within the county or liereafter acquired. <br /> INSTRUCTIONS FOFt TA%CFITEGORY NUM9ER AND DATE DESIGNATIONS APPEAR ON TME BACK OF EORM. ' � � <br /> ' � �T� Total�Fo� <br /> � Gatpory� Trx P�riod Dan Du� Amount of Tuc penalty Interost iWditions Tax Gtpory � � <br /> � � Numb�r � � � . <br /> 1-01-76 thru <br /> 22 12-31-76 4-15-77 398.00 19.9U 22.90 440.80 <br /> ' f <br /> TOTAL 4�FO.HO �. �� � � <br /> FOR USE OF RECORDINC3 OFFICE . � � <br /> I hereby certify that the Nebraska Department of Revenue has fully complied wi[h <br /> the mvenue lawa of the State of Nebraska in the determination of the amount <br /> shown to be due,and the taxpayer has failed to pay the atnount 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 affecud property of the taxpayer. <br /> Dated this 31st day of �rch ,19�g_ <br /> _.. � <br /> . _ sign , �� , <br /> .���8 Author aa 51 aturs � <br /> . Ma ger <br /> Title <br /> . �� ' � � 4-494•74 Rev.31-77 Supersetles 4-494-74 Rev.1-75 4 � <br /> STATE TAX COMMISSIONER—Whita anC Canary Coples TAXPAYER—Pink Copy GOUNTY OFFICE—Go�tlenroG Copy <br /> , ,r._ <br /> , �_... . .. . . . . . . ...,..._....... . _. . _ . ... _„=--'.._ <br /> .4 n <br /> . . . ��.'i�i•.. .,s <br /> , ��.� �. � � . .. . .. � � ' *�.;' - <br /> . . . . . � i,," .,: ' <br /> __ .. . . . . . Z..,a ;•'e <br /> „'k� <br /> �.�' ;;; - <br /> � � <br />