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.fir a t <br />Ulin Serial Number <br />Lion Type <br />Date <br />social security Number, <br />Penalty <br />9/03j911 <br />2 Original <br />0 Renewal <br />3-10-89 <br />all :L0131 7 <br />Nebraska I.D. No. <br />County <br />Lien Filed With <br />Spouse% S�rlcfal Security <br />v <br />Register of Oe" <br />Number <br />5647479 <br />Hall <br />E] County rlork <br />BUSINESS NAME AND LOCATION ADDRESS, <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Nebraska Pallet, Inc. <br />Street Address <br />Street or other Mailing Address <br />1215 East <br />City <br />State <br />Zip Code <br />City Zip Code <br />Grand Island — <br />This Notice of State Tax Lien is Issued by the Nebraska Department of Revenue for unpaid i6k pursuis t to the <br />revenue laws of the state of Nebraska. Notice is hereby. r L a that taxes including penalties and intetesi4. vtdii0 pre <br />shown below. are due from the taxpayer specified abqNe.�3 . remain unpaid,atier demand. Thek taxes &iWait4te <br />a hen in the coiuf�, for real and personal property bele, 6tltegw,-,7ayerar hereafter acquired. , <br />C'T'Z' <br />r4*'Oeriod <br />Data of <br />'AtnouM of Tax <br />Penalty <br />listor*st <br />4saloom <br />Balance of <br />"Assaiment Dug <br />v <br />I hereby =.11 the <br />Minaltio,f", ,,,1 1, =nt she <br />,5 T% Q�, ".2,nof he <br />Lion lakin?jl 11.2 a of an a <br />Sign L <br />Authorized Signature <br />ska Department of Revenue has compiled with the revenue tatyf, of the State of, Alsia-Wka In the dater• <br />be due, and t he taxpayer has failed to pay th a amount duo altinn llama n d. I V ten iV rscte of State Tax <br />s Ilen !t yes to continuo the priority of the state's Interest In•tha affected the taxpayer. <br />Taxpayers Service Specialist <br />Title Date <br />Revenue- Agent Supervisdir -/C <br />Title 0II:0 <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink Copy COUNTY OFFICE — Canary Copy - <br />ry <br />r"I IMA IS (ARE) TO UJIS FILED. ONLY WITH <br />THE MGISTZR OF DEEDS. <br />THE DOCL9UNT (S) IS (AM) NOT TO BE FORWARDED TO THE COUNTY CLERK. <br />DISTRIBUTI(M OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER Or DEEDS AND RETURNED To THE <br />DEPARTIMENT OF REVENUE: <br />LGOLDENROD: TO IP KEPT BY THE REGISTER OF D=S. <br />BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE ?10 PRE-PAYMENT OF -FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />I F <br />