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<br /> ' � 4` { i� YMM i��V4�G �W�t iYf�R ,� . . . . . . . ' ' . ' '
<br /> , � :� �ACttxlNls R��ER TQ TH�SE t�iN8ER5 � .. , , � ,
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<br /> ' :' � li��R.'I�ENT. �i0. , Z(!?tt44� ` � � - -- �- .
<br /> ' ' .' SPQUS� S�C�,5£Cw H0� " 2'.11� �i �!l��IGAN .
<br /> ' • � .�` .•::TA%���E YEA� � : - 1969 � 6RAliD I�6AN0 � NE �6803 .� , , . �,
<br /> ' . �: I.IEi� ;NQ•�. _ , 3i01T70�7 , ;
<br /> . -�� yL��IEqM� Ry�L�ASE 14�•� � • 90233�S1`" . - . '� ,
<br /> . . � f ia/�/Ri i� • Jl�i.� � . . , . .. . . '` • ' .� .
<br /> �. ; DAT� .� �N��iC� . as/01/90 � _ � � � . ` . ,
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<br /> � ; �URStlAMT TO TNE itEMENUE LAMS OF T1iE STIitE t3F NESR�SKAs N�1SitE IS .
<br /> � � � .'. NERE!!Y �IYtN SY TNE i1E8R�SKA DEPAR�MENT E3r REYENUE THA? THE . `
<br /> � ; S'[A�� TAX LI,EN MHICIt HAS B�El1 DULY .�ILEG �6AINST THE ABCYE NAMEB '
<br /> . _. . � � TAXPAYER �itR YNDIVIOt1At INC�ME TAXES SS T�RMTNA�EG. . , � . , `
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<br /> ; � � ` � .I l�EREeY CERtIFY TMIIT THE MEBltASiC� OEPAR7MENT OF REYENUE HA5 CO!lP�I�D.
<br /> � � 1iITH 1HE •R�YENilE LAIiS #�� TlfE STwTE �� MEBRASKA IN TN� llETEitMT�iATI�l� CF ,
<br /> � THIS TE�i�lINA�I�N. .
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<br /> AUYHOit�" SIGNATURE: TITLE � T�Aj� � � t�:
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<br /> • FOR COUNTY GF�IrIAL�S liS� �--
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<br /> �T- _ .___ ._.... ._..._... ._ _. _ ._ NEdEIASKA GEPAR7'MENT CF REVENUE OfFtCES _ _T�__T .
<br /> It yuu I�r��ny ques6pns rapatt�hp th�s nohoo.pkase conL•Yt the��Nxflflu QeparSnent ut Ncvenuo.V U Rio■�34�td.t u�Gp!n,�teDra�ka 6950�4a�8,or FynY a!V�a tp+onal
<br /> dfioN bf(�d bitCw.tn Nfb►aiiio y0u may�150 dil t�tt trep,yaur prg CatiK�c�actvss rt�mtbar a^�tf tl00 742 7074 1or n;��ctam:o �
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<br /> . .�(�0?I'�Ii+70�6..-_ .. NAAFGil.K�•U8219Tt•1G2'D SC�7T5�1.l1FF.-,.l30d1632.t�fY1
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<br /> � -: - -. . -s�'�, ic�x�-oi��■�Muii.� � . :__ --_
<br /> THE [�OCtJMEliT(S� IS 1ARE) NOT TO �E FOAWMDEU TO TiiF COUliTY CLEFtK. �
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<br /> � . WIiITE: TC) BEI VAI�IdATE[7 aY Tll� REGtS'CER OF I�EF4S 11tJD RF•,T't)Rl�TO 'Pb TFlE
<br /> b�Pl1R'PME;t3T (7F F2F.VF•NUE. � .
<br /> L , � GOL�C�T3s T6 0E 1t�FzT f3Y TfiE REGIST�Fi �F D�EUS. ; � �
<br /> BILLIt3G IS TO H� ONCE PER ML7t3T11 M]D mHERE WII.L H��rJU FNE-��AYt•fFN'I' ��' F��S. � � �.
<br /> � '3'iUllJK YOU F'UIi YC1i1R C'C)OPERA7IOtJ. i '
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