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_ Notice of aia><e 1 CIA <br />department a Read instructions on rases side ea�.s/� [/� <br />Oi revenue y(V o i, 0 O 'E <br />Llas SNtal Number <br />Lien Type Oats <br />Social Security Number VVV V <br />al 10 -31 -88 507 -76 -5297 <br />8/11/436 <br />7J Filed With SpOUfe's social Security <br />Nebraska 1.0. No. County ! on <br />' <br />(s Register of r."d Number <br />5254051 Hal l EJ County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Name <br />Business Name <br />Jo ce Riddle <br />Street or Other Malting Address <br />Street Address -- <br />P.O. Box 57 <br />5tafe Zip Code City <br />City state Zip Code <br />NE 68876 <br />Shelton <br />This Notice of Sate Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue Lws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest. which are <br />shown below, are due front the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a Gen in the county for real and personal property `,e asging to the taxpayer or hereafter acquired. <br />sign <br />hire <br />t <br />i. <br />r <br />1 hereby Certify that the Nebraska Department or ners,,..c ,•a• ��•••�• `- the amount due after demand. If this NCtICe Or Duce i.� pay <br />.11natlon of the amount Shown to be due, and the tax pi Yet haS tatted ty of <br />Lien is an extension of an effective lien It Serves to continue the priority Ol the state's Interest In the aflKted property O a taxpayer <br />Revenue Agent ______ —_ <br />Date <br />Title 1,y/ly <br />Dreparer's i nature ((, a ` - y / <br />Revenue Agent Supervisor "7 <br />71t Ie Date <br />l <br />. 1 <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy <br />COUNTY OFFICE - Canary CODY <br />THE ATTACHED NOTICES) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH <br />:HE REGISTER OF DEEDS. r <br />THE DOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK. �. <br />DISTRIBUTION OF COPIES: <br />WRITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT OF REVENUE. <br />GOLDENROD: TO BE KEPT BY THE REGISTER OF DEEDS. <br />BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE NO PRE - PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />