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�rnabraska Notice of State Tax Lien 89. 100661 Partn+ent •Read Instructions on reverse side _. pi revenue �LiellSerlal Number Lien TYPO gate Social Security NuMDOr (& original 506 -58 -7651 9/021816 C7 Renewal 2 -7 -89 Nebraska I.D. No. County Lien Filed With Spouse's Social Security ® Fteglster of Qeeds Number 4871995 Hall ® County C10114 BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Name Business Name John R. Galvan street or other Mauln9 Address Street Address 208 North Darr Street City State zip code city state zip Code Grand Island, NE 68801 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid. taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute a Hen in the county for real and personal property belonging to the taxpayer or hereafter acquired. Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due Tax GteaorY Tax Period Number Ol 10 -01 -85 thru - - hers Title l e r' gnat Revenue Agent Supervisor 7,94191 70-1-SR 01 -01 -86 thru FOR COUNTY OFFICIAL'S USE 4 07 -01 -85 thru the attached notice of State Tax Lien IS -to be with n-nn IB 91 Nhite Coav - To be validated by Register of Deeds and County Clerk, and 1 returned to the Nebraska Denartment of Revenue. Canar Copy - To be kent by the Register of Deeds. Goldenrod Copy - To be kent by the County Clerk. Thank you for your cooperation. ., TOTAL ! $ 823.85 t fiereby certify that, the Nebraska Department of Revenue has compiled with the revenue laws of the State of Nebraska in the deter 4 per to be due. and the taxpwyer,-h2s failed to pay the amount due after demand. if tills Notice of State Tax rrit oft ohat.thci Lien Is an suer of ah eff We lien it rues to ca tlnue the priority of the state's interest in the affected property Of the taxpayer. 3106 Taxpayers Service Specialist Data hers Title l e r' gnat Revenue Agent Supervisor 7,94191 cLd 4-1 + Title Date AuthoriZed Signature• FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink Copy COUNTY OFFICE — Canary Copy _ filed both the Reqester of the attached notice of State Tax Lien IS -to be with DeedsAnd the County Clerk. The Register of Deeds is requested to forward this document to the County Clerk Nhite Coav - To be validated by Register of Deeds and County Clerk, and 1 returned to the Nebraska Denartment of Revenue. Canar Copy - To be kent by the Register of Deeds. Goldenrod Copy - To be kent by the County Clerk. Thank you for your cooperation. .,