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o� <br /> ��Q� ' .. . .. � NE irc oO SkO�o , YCG . S�L . <br /> � i Illlll lilll lllll lNII 11111 illil 1111 Ill1 <br /> r» Fii�adEQa°iwasiz000 e; 45 Pr� <br /> , 20U000 ? 5r <br /> � NotiGe of St�#e Tax Lien <br /> � <br /> �� <br /> ��. <br /> ' PLFASE DO NOT WRITE IN THi$$pACL <br /> This Notkc oP State Tax Lien is�eu�ed by the Nebraska Department p[ <br /> Revpnve ibr unpaid taxe� pnrsaant eo tb,e r,even�re laws of the state of <br /> Neb�c�aska, Noti�ee is he.reb' given that ta:es fncludtng pea�ltiea aad <br /> luterest, wbkb are showd below, are duc fmm t6e ts��payer speci6ed <br /> below and t�euwiiu papaid alter denwnd. These t#xes eous�itule a lien In <br /> tbe oouaty ibr real sud personal prvperty belonging to the taxpayer or <br /> ber�tter�cquired. <br /> �lebr Itl ' Nurnb�r L,ien Fted Wrl� Sacial Seourily a Fe�ral I.D,Numher $ppuse'e Saiel$ecuftty NufnCer <br /> 8215553 �7Raei�aa�es �cou"�c��x 505-$5-255$ <br /> �i�n Sqrial Number Eien lype L1ata of Lien Cour�ql <br /> 00 oz 300 ���� o��^ ❑� oi—o3-2voo �zz <br /> 6USINE55 NA1A�AND LOCA110N ADDRESS TAXPAYER NAME AND MAlLING ADDRESS <br /> BkSin1'!9S N81fl6 Namq . <br /> IAM OLMSTEAD <br /> Streat Ad�!eBs SRtoet or OiMr Maibng p,ddraes " <br /> � S� S B <br /> �caae cny �re �p coda <br /> � Belanea et <br /> �ak ry Tax Perlod ���� Amount a�Tex Paflalty tnterea! Addfklon: Asgpsn+�rrt Du� <br /> a4—�e-9�— <br /> 8-3 —9 Z2— - 349 11 0 358 6� <br /> Retum to: <br /> ST��'E OF NEHFtASKq <br /> DEPARTM�NT�F R�VENti� <br /> 1811 WEBT 2ND 8T STE 4SQ <br /> GRANp ISLAND N�88803 TOTAI. $ �5 g ��2 <br /> I hareby certify q�at the Nebraska Departinent al Revenue has aompned vNln Iha revgnua laws os ttw State af Nebraska in�e d��ination <br /> w the amouM shown w be due,and ttre taxpayer has(aNeo to pay tne amount due a}ter domat►e. Ii this Notioe of Ssate Tatt ven is an�ctansicn ot <br /> an eryecOve iiert,it eervea v aontlnue the prbrny of the stata's irM� the alfeatatl pr 1� ffixpayer, <br /> S��n � � / � .� <br /> h�re ����ss��� . � �e � -���e� <br /> � <br /> � i <br /> NEBRASKA DEPARTMENT rJF REVENU • ite end Goldenrod Copies TA?CPA •Pink Capy GQUNIY OFFICE•Candry Copy (,;_ ( <br /> �A'YMa p�n1�tiWd e�O�Y e�at.i�Qeu �etiee G,..�e.ew.e uod�a qW.S�BS t, . <br /> ��'�'d N�ISIr1IQ J'�'fl tJd��:9�7 �0: ;'� hlJl <br /> _ � <br />