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L i r�nehraftra arttnent , Notice of State Tax Lien • Read instructions on reverse side LienSeriil Number r Date Social Security Number L i r�nehraftra arttnent , Notice of State Tax Lien • Read instructions on reverse side LienSeriil Number Lien Type Date Social Security Number Interest Additiata iX Original r� 5 -3 -89 Ausssment 9/05/140 (; Renewal Ax it 1p� 1 ;A ■ 2 3 1 Nebrasks 1.0. No. County Lien Filed With Spouse's Social Security Register of 04edS Number V V v 5107067 Hal 1 County Clerk _ BUSINESS NAME AND 0usfness Name Street Anr =055 RT7t7MX,A_ %rA;�hS1G�Oa � .. or Other AddlresS al AV,, _ Suite 136 City State Zip Coda City State ZIP ceue Grand Island, NE 68803,__ This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice iN hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpaycr tx Hereafter acquired. F.umber T:>s ategory Tax Period Oats of Amount of Tax Penalty Interest Additiata Balance of Assessment Due Ausssment I hereby certify tn0` •:re N.3'D'aska 03par'.f -w,t. L� Revanue has complied with the revenue laws of the St,V ^c•94 Nebraska to tfte CUtdr, mination of the ama.,r- snJW� ce Cav, and mo taxpayer has failed to pay the amount due attar demand. It fnis Notice of State TiA Lien is . r ex , . c? an effect. a hen It servos to continuo the r Ortty of the state's interest In the affected property of the taxpiyor. sign Tax yers Service Specialist •here Ti to Dato S RAMUR Agent Ipprvisnr A arI ad Signatu a Tltlo Date FOR COUNTY OFFICIAL'S USE __,(NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copies _ TAXPAYER -- Pink Copy ^` COUNTY OFFICE Canary Copy THE ATTACHM NOTICES) OF TAX LIEN (OR TERMINATION) IS (ARE) 2 +J BE FILED ONLY WITH ^^^ THE REGISTER OF DEEDS. s THE DOCUMENTS; IS }(ARE) NOT TO BE FORWARDED TO The tx U4VrY Clirsn. DISTRIBUTION OF WHITE: Ta v = t 7L-n' A111-0 BY THE REGISTER Cr M=011 • A1111- :1191 -Tim.) D TO THE DEPARTMENT OP RF,VF'NUE. GOLDENROD: TO BE KEPI' BY THE REGISTER OP I313IMS. BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE 110 PRE -Pn-ZN U or FEES. T11ANK YOU FOR YOUR COOPERATION. i n 4 r� •