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r. ti ON _1 Notice of State Tax Lien FlIpEeIvnenue raska Mani a Read inatr6etions on revere aids, Llenserlat NumUr Lien Type Oat& social security Number Penalty InUrest L Orig inal Balance of Number , 9/02/841 Q Renewal 2 -13 -89 507 -32 -8341 on— f a�� Nao:aska Lo. No. County Lien Filed WWI Spouse's Social Sacuifty i] Register of Wed• Number 1672141 Hall ❑ County Clerk BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Nama Jahn H. 8aasch Streat A 44ren Street or Otnar Mailing Address 108 North Broadwell City State Z, , Code City State: , zip Code Grand Island, 68801 This Notice of State Tax Lien i's'ssued by t!ie Nebraska DeparMn tcg Reiaaaz ,ar unpaid Lames pursuant to the revenue taws of the state of Nebraska. NoSve Is hereby given that - (,%j�m':ncludiitg penalties mt interest, wbich are shown below, are due from the taxpayer specified above and remain unpaid aftea demand. These taxes oar&tute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. Tax CA'.*wry Tax Period Date of Astestment Amount of Tax Penalty InUrest At-d -Iiora Balance of Number , ! Assessmont Ous I WNW certify thp' f,31 Ne0 raska Oepartrrlent of Revenue has compiled with the revenue laws of tFe State of Nebraska M the deter - M1.110 n of a111"Wi *-Jn.own to be due, and t:%- taxpayer has failed to pay the amount due after derljrro. 1f this Notice of State Tax Lien Is a nsfon Van Orectiv n, it Serwq't W continue the priority of the state's Interest In the affe:ied property of the taxpayer. Non �'�� Taxpayer Service Specialist r /�� here flit, ynaturre Title Date �- c Revenue Agent Supervisor �-g- /Z/- rued Sigr.a", r Title Date FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMEN'r OF i:mvemue — White and Goldenrod Copies TAXPAYER — Pink Copy COUNTY bFFICE - C tieV Copy THE ATTACHED WiTICE(S) OF TAX LIEU (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH , 711E REGISTER OF DEEDS. THE DOCUMENT (G) IS (ARE) NOT TO BE FOXIARDED TO THEl CCWtJ'I'Y erEPK. DISTRIBUTIOTI OF COPIES: WHITE: TO BE VALIDATED BY THE REGISTER OF DECt7S AND RETURNED TO THE DrPARTMETITI' Or' nt•7V"n1—. GOLDENROD: TO BE KEPT BY THE REGISTER OF DEEDS h. BILLING IS TO BE ONCE PEk MONTH AND THERE WILT• SP NO PPE•- VAYMENT OF FEES. a `tHWIF YOU FOR YOUR COCIPPRATI01S.