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1 s J. Notice of State Tax Lien 1pizigat enun •Read inittructionson ravens side Lion SerW Number Lien Type Oats Social Security Number Penalty lntr•. s. ` ® Original Assessment Due NumberYi� ❑ Renewal -15.9 507 -70 -2434 89— i��Q Nebraska I.O. No. County Lien Filed With Spouse's Social Security jj Register of Deads Nurnbtr 4174984 lHall I 0 County Clark 524 -90 -1483 BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILINIM ADDRESS, Business Name Name Derr W. 6 Laura L. Parsons Street Address Street or Other Mailing Address 121 N. Grace Avenue City State Zip Code City State Zip Code Grand Island, NE 68803 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the retvnue laws of the state•of Nebraska. Notice is hereby given that taxes including penalties and interest +which are ska" below, are due fik;M' 6. -the tax}ia +er.. specified above and remain unpaid after demand. These taxes constitute x.4en in the chanty for rt:a and perstjnat- erty belonging to the taxpayer or hereafterau" Ig" fired. Tess Date of Batanea of -, +•.. ^..-2, -i • . Trri Fsrioo Autaunt of Tax i -u i -tsi cnru 36 -30 -87 7 -17 -87 150.50 0.19 U.02 184.71 :0TAL S 184.71 1 hereby certify that the Nebraska Department of Revw. ve has complied with the r11vou:.6 iays of the State of N_"raska In the detev- rrinatloh Of the aunt snow to be due, and the taxpa:-/er has failed to pay the a:Y.c4nl d!aty 0"or demand. If VMw 11011ce of State Tax Lien IS an a on of an of fee ve Ilan it Wyes to cons 1f the priority Of the state's +1aL•reSt in the affected prCp+JtCy of the taxpayer. sign Taxpayers Service Specialist heir r' gnat Title Date Revenue Agent Supervisor 07_- Res - Autho tl Slghatur + Title Date I h FOR COUNTY OFFICIAL'S USE 1 7 tide, —i_ NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER •- Pink Copy COUNTY OFFICE - Canary Copy THE ATTACM NOTICES) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH —_ THE IMIS -r OF DEEDS. .r THE DOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK_ DISTRIDiY V.; OP COPIES: WHITE- TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE DEPARTMENT OF REVENUE. GOLDENROD: TO BE KEPT BY THE REGISTE9 OF DEEDS. 81LLIIIG IS TO BE ONCE PER MO;iTH AND THERE WILL BE NO PRE— PAYM12;T OF FEES. r• 711ANK YOU FOR YOUR COOPERATION. Ama°nant Penalty lntr•. s. ` ii r.w„ +nom► Assessment Due NumberYi� i -u i -tsi cnru 36 -30 -87 7 -17 -87 150.50 0.19 U.02 184.71 :0TAL S 184.71 1 hereby certify that the Nebraska Department of Revw. ve has complied with the r11vou:.6 iays of the State of N_"raska In the detev- rrinatloh Of the aunt snow to be due, and the taxpa:-/er has failed to pay the a:Y.c4nl d!aty 0"or demand. If VMw 11011ce of State Tax Lien IS an a on of an of fee ve Ilan it Wyes to cons 1f the priority Of the state's +1aL•reSt in the affected prCp+JtCy of the taxpayer. sign Taxpayers Service Specialist heir r' gnat Title Date Revenue Agent Supervisor 07_- Res - Autho tl Slghatur + Title Date I h FOR COUNTY OFFICIAL'S USE 1 7 tide, —i_ NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER •- Pink Copy COUNTY OFFICE - Canary Copy THE ATTACM NOTICES) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH —_ THE IMIS -r OF DEEDS. .r THE DOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK_ DISTRIDiY V.; OP COPIES: WHITE- TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE DEPARTMENT OF REVENUE. GOLDENROD: TO BE KEPT BY THE REGISTE9 OF DEEDS. 81LLIIIG IS TO BE ONCE PER MO;iTH AND THERE WILL BE NO PRE— PAYM12;T OF FEES. r• 711ANK YOU FOR YOUR COOPERATION.