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r <br />ne0ratika <br />U»ef►t <br />a <br />Notice of State Tax Lien <br />*Rand instructions an reverse tide <br />Lien Serial Number <br />Lien Type <br />Ditto <br />Social Security Numher <br />Penalty <br />�- <br />8g1 <br />original <br />I Rer_eWal <br />_ <br />505• -20 -3510 <br />�.•••�• <br />♦ /\ /� <br />_9/Q1 <br />Nebraska I.D. No. <br />County <br />L�i-e1n Filed With. <br />Spoute9 Social SetUrity <br />dl Register of peed, <br />Number <br />�, ■00 <br />699802 <br />Hall <br />Q County Clark. <br />PUSINESS NAME AND LOCATION ADDFIFSS <br />TAXPAYER NAME AND MAILING ADORESS <br />Business Name <br />Name <br />William F.; Burton <br />Street Address <br />Street or Other MYalling Address <br />505 W. Stolley Park <br />Road <br />city- <br />State <br />Zip Code <br />city <br />State T.ly. Code <br />Grand Island <br />NE 68801. <br />This Notice of State Tax Lien is bsuedlby the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraskar.Notiee is hereby given that taxes• including penalties and interest, which are , <br />shown below, are due from the taxpoiyer spmified above and remain unpaid after demand. These. taxes constitute <br />a liewin the courtly for real and personal ptepeaty belonging to the taxpayer or hereafter acquiiled, <br />Tala <br />Category <br />Tex Period <br />Date of <br />Aesesslnsnn <br />Amount of Tax <br />Penalty <br />Interest <br />tAdt!i ass <br />Balance of <br />A"assmnat Ow <br />NwnBr®o <br />i.; <br />1– <br />■ <br />I hereby certify that the Nebraska Department of Revenue has compiled vnith the revenue laws of the State of Nebraska in the deter. <br />mihation 01 S mount sh n to ;be due, and the to ayet has failed to payithe amount due after demand. If this Notice of State Tax <br />Lien ie an Sion of an a tl,, Ile serves to c tlnue the priority of the state's Interest In the affected property of the taxpayer. <br />r ' <br />�D Taxpayers Service Specialist 1- 9 -89'i <br />het tear . Title Date <br />Revenue Agent Supervisor 1 -9 -89 <br />Authorized Signature Title I. Date <br />OR COUNTY OFFICIAL'S USE <br />RAFSKA t) Py tTINENT O FAEiVENUE – White-and Goldenrod Copies TAXPAYER –Pink COPY _ _ .COUNF"f OFFICE ­ "w0ry Coen <br />Tilt T ACHtP NOTICES) OF TAX LIEN (OR TEMIJOTION) IS (ARE) TO BE FILEil�'+Y WM <br />TWIG 'IL1m0 ISTEA OF DEEDS. e <br />THE 010CUP E]ITT(S) IS (ARE) ' NOT TO BE FORWARDED TO THE COUNTY CLERK. <br />DISTRXBUTION OF COPIES, <br />WHITE'. TO BE' VALIDATED BY THE REGISTER OF DEEDS AND' ?NEED. TL!O THE <br />DEPARTMENT OF REVENUE. <br />GOLDENROD: TO BE KEM BY THE REGISTER OF. DEEDS. <br />BILLING IS TO BE ONCE PER MONTH AND THERE W.T..LL BE NO PRF.- PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />i.; <br />1– <br />