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�� it, <br />" � '� a s, ay;; �. ?�. �.�'�e.-'����..,- _ ,�� �.-,;M►^4'+7! <br />Notice of State Tax Lien <br />�»ebraska• <br />r2epx.. »me It a Read instructiorK on nmww side <br />Lien Serial Number <br />Uen Type <br />Date <br />SOCISI Security Number <br />Penalty <br />9/0 028 <br />J0 Orlglnal <br />[j- Renewal <br />1-9-89 <br />- - <br />VVeae� 102121- <br />Nebraska LD. No. <br />County <br />Lien Filed With <br />(Spouse's Sock.-I Security <br />699802 <br />Hal 1 1 <br />E] 'Register of Deed <br />umber <br />County Clerk <br />F BUSINESS NAME AND LOCATION ADDRESS <br />12 -31 -85 <br />3 -27 -86 <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />1 3.76 <br />31_ <br />Nam <br />Wilburn <br />F. Burton <br />Street Address <br />Street or Other Mailing Address <br />505 W, Stalley Park Road <br />City <br />State <br />Zip Coda <br />City <br />State zip Code <br />13.21 <br />63 '5 <br />1 <br />340.73 <br />IGrand Island <br />NE 68801 <br />This Notice of Sta!e Tar Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interrit, which are <br />shown Mow, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Category <br />Tax Period <br />Date or <br />Assessment <br />Amount of Tax <br />Penalty <br />I :-:=wt <br />Additions <br />Balance of <br />Assessment Duo <br />Number <br />10 -01 -85 thru <br />21 <br />12 -31 -85 <br />3 -27 -86 <br />0.00 <br />17.84 <br />1 3.76 <br />31_ <br />01 -01 -87 thru <br />21 <br />03 -31 -87 <br />4-30-871 <br />264.27 <br />13.21 <br />63 '5 <br />1 <br />340.73 <br />04 -01 -87 thru <br />21 <br />06 -30 -87 <br />7 -31 -87 <br />273, 1 <br />13.66 <br />55- 2 <br />341-99 <br />07 -01 -87 thru <br />21 <br />110-31-871 <br />346.96 <br />17 35 <br />56-56 <br />420-87 <br />10 -01 -87 thru <br />I <br />21 <br />12 -31 -87 <br />1 -31 -88 <br />96.5r, <br />4 93 <br />12.97 <br />116•Q� <br />TOTAL I S 1'241.65 <br />1 hereby certify that the Nebraska Department of Revenue ha; compiled with the revenue laws of the State of Nebraska In the detc, <br />n- .:nation oft amount sh wn to be due, and the tzxpayer !ias failed to pay the amount due after demand. If this Notice of State Tax <br />Lien Is an nslon Of an ",-five Ile. L �Sery o On tlnue the priority of the state's Interest In the affected property Of the taxpayer. <br />Slg. _ Tanavers Service Specialist <br />:hire or's 9 lure Title <br />Revenue Agent Supervisor <br />1 Ad_3horized Signature Title Date <br />FOR COUNTY OFFICIAL'S USE <br />� 1 <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAY ER - Pink Copy COUNTY OFFICE - Canary Copy <br />THE ATTACHED NOTICE(S) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH <br />THE REGISTER OF DEEDS. <br />THE DOCUMENT (S) IS (ARE) NOT TO BE.FOMIARDED TO .Ti3D COUNTY CLERK. <br />DISTRIBUTION OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT Or PPV. T- tt <br />GOLDENROD: TO BE KEPT BY THE REGISTER OF DEEDS <br />4 <br />BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE NO PRE— PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />