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Notice of State Tax Lien <br />brask a <br />lofr. et <br />z •R*Winitrudionrvn-rw4naside <br />Lien Serial Number Lien Type fiato social secuilty Ninlber <br />�� Orfgmat , <br />4/05/060 Renmvat _ 5 -11 -84 506 -50_- 2_905. gg�- 25 <br />- Nebraska I.G. No. County Lien Feed VJ)th 5pouse's Soc<st fi�c•, +fir 102 <br />;j Register of DaedtNumbcr f <br />3940373 Hall � cn14nty Clerk �_ t_;i -w_- <br />^ BUSINESS NAME AND LOCATION ADDRESS _ � l"PAYE R NAME AND MAILING ADDRESS <br />Bus +ness rvame l�n +1;� �� <br />Bourbon Cowboy - �Larry,H�fbbs <br />Street Address $trypit or (Other rdulting Address <br />609 South Locust 716Stuhri Road <br />City state Zip Code ifItto, state Zip Code <br />Grand Island NE 68801 Grand''Island NE 68801 <br />This Notice of State Tau Lien is issued by the Nebraskit Depprbnent of Revenue for unpaid taxes pursuant to th€ <br />revenue laws of the state of Nebraska. Notice is hereby - given thtit taxes including penalties and interest, which are ' <br />shownt below, are due from the taxpayer specified above -and remaid,unppid after demand. These taxes constitum.: <br />alien in the county for real and personal property belongirtg:to.the taxpayer Itx hereafter acquired. <br />J <br />I Tax <br />Tax Period <br />1 <br />Oats of <br />Am t <br />Amount of Tax <br />1 • <br />y pone w., <br />Interest <br />Additions <br />Balancer of <br />p�,�ent Rue <br />NCa <br />1 hereby 1�s -.. the` tole Nebraska Department of Revenub h!. confpliW with VIC rec2auetaws of the state of NO;tarai-.4'l^ •t�:crritar- <br />t!2inatlon of Ile oun2 s--wn to be due, and the taxoaygcr ha; fa-11,3 to pay the am4llunt Jue after demand. If thtr. Lfn_1b ct' =,g';3 Tax <br />n iS an ex on of arc• affect) hen it rves to connr:..a tale nrtnrity or trio state -s irtorest in trio affected pr6l:drt; , :` t`a'r :ax,;ayer. - <br />sign �/ Taaayers Service Specialist <br />here ikV g Title tyate <br />Autnorized signature R Agent Supervisor <br />V Title i 1� Will <br />FOR COUMV .OFF MAWS USE <br />'r <br />NEBRASKA DEPARTMENT OP R EVENUE — White and Goldenrod Copies TAXPAYER P -0 Copy � COUNTY OFFICE Canaty Copy <br />n nV4.ra Np,: 0•flfl <br />The attaches! Notice of State Tax Uien is to he filed with both the Reqister of <br />Deeds and the County Clerk. <br />The Register of {feeds is requestirVta• forward this document to the Countv Clerk. <br />White Copy - To be validated by the- 11elister (if heeds and County Clerk, and <br />returned to the rlebraslca Cenartntent of Revenue. <br />Canary Cop - To be kept by thr- Register of Deetls. <br />Goldenrod Cooy - To be kept try thn CatinEy clerk, <br />Thank you for your c©oneratir,,% <br />�h <br />j'. <br />R <br />r <br />r <br />