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+ � re*.- a au a F Notice of State Tax Lien a Rnad hingttuenons on mversa side Lien Serial IN A. i Number Lien Type ortginal Oats social Security Numbrrr o 101433 85172038 Q aanewal 3 -22 -89 505 -38 -6794 Nebraska I.D. No. County Lien Fitttl.Nith Spouses social Security 29470099 Hall fl Register of Deeds Number County Clerk 507,51-5 M BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name tame :r`i�arles & Lena Mettenbrink Decd Street Address Street or Other Mailing Address Box 759 City . State Zip Code City State Zip Code Grand Island,- NE, 68862 This Notice of State Tax Gen is issued by the Nebraska Department of Revenue for unpaid taxesr pursuant to the revenue laws of the state of Nebraska. Notice fis ftereby given that taxes including penalties and intro- t, which.are shown below, are diie fxvtln the taxpayer speLWed above and remain unpaid after demand. These taxes constitute alien in the county fbi i tl andlpctonal property belonging fr t le taxpayer or hereafter acquired. Tax a Tax Period Data of Assarament Amount dfl:�i Panahy Interest Ar ditiQrm 8atunpa of , AssestiT►smtiDu4' w Number Num I heresy Certify that the Nebraska Depar:.-ner.r ;• Psvenuo has Compiled with the revenue ta{vsz °the State-t-• Nebraska In the deter- mination of the amount shown to be duo, and Vie tixsayer has failed to pay the amount due altar 3ema^q: ! V11111 Nottee of State Tax Lien Is an ex an of an effective Hen it serves i:3 : t•.'inue the priority of the state's Interest In the affacte" gw"Iperty of the taxpayer. • sign ti Revenue Agent Supervisor -13- h9F18 Prepces-s7and Title Date Revenue Agent Supervisor, 2-7-3 - Authorized Signature Title Date FOR COUNTY CfFICIAL'S USE s NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy ,:.: s_ i .. COUNTY OFFICE -- Canary Copy 4494.74 Rev. 9.80 Supersedes 4.494.74 Rev_ 7.81 n b