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f <br />F <br />Notice of State Tax i <br />�eDwska <br />Li <br />en <br />department <br />tlr115of revenue *Read instructions on reverse side <br />Lien Serial Numper Lien type Date Soclaf sac-Ity Numper ­7 <br />89020023 <br />X1 Orminal <br />U Renewal <br />^_ — �r~ <br />_02 -09 -89 <br />Nebraska I.D. No. <br />11734302 <br />County <br />Hal 1 <br />Lien Filed With <br />(gi Register of Deed <br />County Clerk <br />Additions <br />BUSINESS. NAME AND LOCATION ADDRESS <br />Business Namo <br />01 -01 -82 thru <br />1 -x.-82 <br />1- <br />Street Address <br />5 Q <br />;. 47 <br />Douse's Social Security <br />umber <br />City State Zip Code <br />City <br />89-- 1-30739 <br />TAXPAYER NAME AND MAILING ADDRESS <br />or Other Mal IIn, Address <br />State <br />This Notice (if State Tax Lien is issued by the Nebraska Department of Revelnue for unpaid taxes pursuant to the <br />revenue lgws of .the state of Nebraska. Netice is hereby given that taxes including penalties and interest, which are <br />SA. ow, l bda', • use due from the taxpayer specifted •above and remain unpaid after demands. These taxes constitute <br />M Itch;% the cmiAtY for motand personal property 6etctirging to the taxpayer or hereafter scqutr�. <br />Zip Code <br />Tax <br />Category <br />Number <br />Tax Perloa <br />QaJxnaf: <br />Assos=latt <br />Amnsrnt of Tax <br />Pi*nAlt /. <br />fcterest <br />Additions <br />Balance of <br />Assessrrtettt Ow <br />22. <br />01 -01 -82 thru <br />1 -x.-82 <br />1- <br />11 <br />5 Q <br />;. 47 <br />702.61 <br />!01 -01 -83 thru. <br />12-31-83 <br />1-12-89 <br />- <br />112-89 <br />333-45 <br />64.45 <br />83.36 <br />174.13 <br />178.54 <br />595.35 <br />22 <br />01 -01 -84 thru <br />12-31-84 <br />01 -01 -86 thru <br />- - <br />1-12-99 <br />_ <br />910 <br />-12_ <br />--- --------- <br />TOTAL <br />S <br />..aWO- 1-11r Or nevonue nas compiled with the revenue IaWS of the State of Nebraska In the deter- <br />mination of the amount shown to be aue. and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax <br />Lien is an extension of an effective lien It serves to continue the priority of the State's Interest In theatiected property of the taxpayer. J. Sign Taxpay PrC Seryicim 'U ialict e5R <br />here IF Pt or ature Title Date <br />Ruenue Anent Sunerviser - x;-6'9 <br />uthor eed Signatur Title - Date <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink Copy COUNTY OFFICE — Canary Copy <br />THE ATTACHED NOrTICS(S) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH <br />THE REGISTER OF DEEDS. <br />THE DOCLIH TT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK. <br />DISTRIBUTION OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS Ah"D RETURNED TO HE <br />DEPARMENTT' OF REVENUE. <br />GOLDENROD: TO BE KEPT BY THE REGISTER OF DEEDS. <br />BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE NO PRE — PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />t <br />i <br />, <br />h <br />,l iL7 <br />V <br />i <br />,a <br />