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<br /> . , . � , • T�R!lINAT�i�7M OF STATE TAX lI�A1 , � , . •
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<br /> i IF �flp IN.QUIRE AEtlU'� YOUR - . •
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<br /> - --- - _ '- .;� Il[�OLK'�f REF�R TQ.THE3� !lUNBERS ` „ .
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<br /> � - . ' iOC• 5��. t10•. :5A3689fl85 YAtiCE K E L�RETIA � WIU(INSt}i� � . .
<br /> , � , ' ;. ��R� IDENT� M�• 11978732 . ' ' - � � , � . .
<br /> � � ' "�SPE�S� �SOC. S�C. 4�. 5t#$4T5�G6 � 1?03 5 ADA . � . � _
<br /> � ,� TAl(A�L`� Y�1tR' " ' 1984 �6RAl10 I�LAI� . NE �88fl3 �" � � ' .
<br /> , �. � �SEI�t �. .. . . 40�S�i7�r? - . . , - _ . • . ` • �
<br /> � . , . . LIEN, l�ELE1F5£ IWti. 9'ti21575� . , � - � •
<br /> ' � � tOtJN?Y . . . . � � HAi.L . . . �
<br /> � . � , : i3A1E OF ,I�CtTIGc ' �?8/Q3P90 , � � � : � ,
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<br /> � � ; �URSi�ANT TO TK� ��Y��ii�E, �.AMS OF THE SfiATE 6F NEBYt�SKAs` NQ'C��E� IS ,
<br /> � � � - ; °H�R�$V GIYEN BY TliC ��3RA5KA $1�PART![�wT OF R�YENUE TNA'� THE . - � ,
<br /> • � � �STAT£ TA% tI�N IiNICN� HA�S 8��1� Dtll.Y FIl�g A6AINST TNE AB�Y� NAMED . �
<br /> . : T�XPAY�R �rOR I�it3IYIDUAI.�INCLME TAXES I S 1€CtMINAfEO: ' �
<br /> � I NEREBY C�R�IFy THA? 7HE NEBRASKA O�PAitTNENT OF ltEY�hUE HAS COwPLI£� � •� � �
<br /> � Ili'IH THE i�EV�NWE 1.1►iis oF THf sTATE G� N�eRASKa IN TH� D�TERMiNATiC��i c� �
<br /> � THIS TERMiNATIOtt. ', " � ' . : ;
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<br /> � ��•- •r�r��� '� • �• •��r�s •�• •����•i�1��� - t � .
<br /> , � ER�S S26NA1URE T E/ QATE ! �=_
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<br /> . . AU�NQRIY SI�NAtURE �TI7LE D�Tf � . �
<br /> � FOR COUN�Y OFFICIA�.�S USE �
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<br /> ' THE AT'L'IYCHED MO'liCL(S� O! T7Ut LILTI (OR TEAMIlU1TI011) IS (ARF:� TO HE PII.ED l�„Y �'�'!i
<br /> '!!� *1�.,02'��� !!' A fJ�. •
<br /> ' THE DOC[JMENT (S) IS (ARE) NOT Tn BE FORWAfi.i'iEb TO THE COUNTY CLERK. , �`
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<br /> �ISTRIBUTION OF COPIESs � �
<br /> FiHITE: TO BE V1ILIDATED 8Y 'I'FIE REGISTER OF DEEDS 11ND R�TLJRN�U TO THE
<br /> � . nEPARTMENT OP RF•VE."iUE.
<br /> .. „
<br /> . G01d)ENROAs TO 'SE XEPT BY THE REGISTER OF' QEEDS.... -�-.-- ---- ---�- ..--- ---...._._........ .. .. . .. . ..
<br /> � BILLIt� I$ TO BE ONCE PER MO?JTiI 1tLdD TFIFRE WII.L AE it0 FF7�-PAYMfiNT EJF' F�`F,S. , �
<br /> • ' , TH71NK YOU FOR YOUR COOPERl1TION.
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<br /> NE9C1/ISKA OEPART�AEt�iT OF iiEVfNtiE OiFtCES ' ,,_j
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<br /> , H yauttYvoanyqutsGOn3 rc�ud,np th�s notKO.P'aasQcSlntact tho Nebrp;ka Uepsrtmert of Rovenuo,p Q.Etcx O:Dlii.tmco:n,Netra�..ha 69�09 40�Q.ar uny ot tho�e;,�:r�J
<br /> oH;c�s tist4d debw.1n Nrbr�you may a:o�l�f to!►heo.your�orp G�StittCO 0C_'a5s�umbo+ilnd 800�742•7d74!or ti;;i;.leflCO. .
<br /> ��pW�(�+7�•� GBAND ISlANO--(308)381•5725 NOftTH PLATTE---(309)532-8250
<br /> �MAEiA�—(1p�5oS'7065 , NOAFOLK�(402)371-1620 5R�OTTSBLIIFF-�(30�I632•1200 � f-- --LL.'.
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<br /> . . +n(��U p�PAR�MENT OF q�Y�NUE--Wfute and�an�uy GvpEes TAXPAVER—Pmk Capy � C:OUNTY—GotdenrOd Cayy ;
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