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-_i <br />a <br />Notice of State Tax Lien <br />neArash e <br />dfprrtlnent •Read instructions on reverse s1do <br />o revenue <br />Lien Serial NuUipvr <br />l.=,-nn typo -_ — <br />�,.,_ <br />Ltato <br />L Clvgmal <br />9/05/149 <br />i:_1 Ranewal <br />Tax Btrino <br />5- 30 -89�- -- <br />Nebraska 1 D. Nu. <br />co".1ty <br />Interest <br />Litin Fited Witt, <br />Assompent Due <br />Number <br />i cl oend, <br />4953n96 <br />Hall <br />I County <br />�_ � County ('.lark <br />BUSINHSB <br />NAME AND <br />LOCATION ADDRESS <br />Business Name <br />506 -20 -5371 <br />So:tat Security <br />TAXPAVER NAME AND MAILING ADDRESS <br />Street Address Street or other Malling Address <br />106 East Third Street <br />City state 2io Code City State <br />Grand Island, NE 68E <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />Isvenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid aftHr demand. These taxes constitute <br />a lien in ttre county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Zip <br />Tax <br />9etlina of <br />Cateoory <br />Tax Btrino <br />Rati of <br />Amount of Tart <br />Penalty <br />Interest <br />Addition <br />Assompent Due <br />Number <br />Assesiment <br />1 here',7y certify 1116. C"--G !vcarafns - -epartment 4r Qeven ^Q has cocooned with the revenue laws of the State Qt' Met ^asl*& In the deter- <br />- minatton of the ouRt 9'IG '-t to ae� a.te'. and the tacpayei has falitld to pay the a -nount due after demand. It l; ^,'.S Noce 01. State Tax <br />Lien Is art ex on oil 4C eft tNC .ie^. it _s to. time the priority of the ttttmY. interest in the affected pro6,*rty of the taxpayer. <br />sill �1�'"�' _ Taxpayers ServicO 'Svecial ist <br />�.�� i 5l ure Title ''. Date <br />Revenue Aaent,Supervi sor <br />A rir d Sisnatwe Te Date <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE — CanstY Copy <br />THE A'ITPAM ? 11OTICE(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 FORWARDED TO THE COUNTY CLERK. <br />DISTRIBUTION OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />f DEPARTMENT OF P.EVENUE. <br />L GOLDENROD: TO BE KEPT BY THE REGISTER OF DEEDS. <br />BILLING IS TO BE ONCE PER MODTH AND THERE WILL BE NO rRF.- PAYMFNT OF FFVS. <br />T1tANX YOU FOR YOUR CUUP> RATION. <br />a <br />c <br />F" <br />r, <br />au; <br />A <br />v <br />