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1 <br />INSTRUCTIONS <br />PURPOSE OF FORM, This form is to be used by the Nebraska <br />Department of Revenue for the purpose of notifying the appropriate <br />county authorities that a Notice of State Tax Lien is being flied <br />against the taxpayer indicated on this form. <br />�' Tisa tsar category cumber codes and the Nebraska tax programs they <br />represent are listrd below. <br />01 ... ...... . ................ Sates Tax <br />02 ........... .......... Retailers Use Tax <br />04 .... Consumers Use Tax <br />10 .............., :.............. Pari-mutuel <br />21 .......... .... Income Tax Withholding <br />22 .......... . ........ Individual Income Tax <br />23 ....... , . ............. Fiduciary Income Tax <br />24 ...........Corporate Income and Franchise Tax <br />36 ...................Documentary Stamp Tax <br />44 ............ Mechanical Amusement Device Tax <br />4S .......................... Severance Tax <br />46 ............... _ ............ Estate Tax <br />47 ............. .........Cigarette Tax <br />67 .............. ............ Litter Fee <br />68 ... ........... ............ Lodging Tax <br />71 ............ Interstate Motor Carriers Fuel Tax <br />81 ...........Motor Vehicle Fuels ImportingDealer <br />8S .......................... Aircraft Fuels <br />91 ............................ Special Fuels <br />rp <br />V = t. <br />no <br />''+ = O D <br />CA <br />� O <br />i� <br />t <br />• i <br />i <br />