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r <br />1 <br />>r <br />i <br />Mbrasks <br />tment <br />nl rav4nut! <br />I <br />Notice of State Tax lien <br />411itead instructions on reverse side <br />Lien Serial Number <br />Lien Type <br />Date <br />Social Security Number <br />Penahy <br />f nhlneet <br />9/06/273 <br />►E Renew' <br />l7 Renew„ <br />6 -20 -89 <br />5Q6 -6Q -6632 <br />ar i0325� <br />Nebraska I.D. No. <br />County <br />Lien 111`11e0 With <br />Saou"Is Social Security <br />5675901 <br />Hail <br />13 <br />rClarkeed <br />Number <br />county <br />BUSINESS <br />NAME AND LOCATION ADDRESS <br />TAXPAVER NAM AND MAILING ADDRESS <br />Business Name <br />Name —� <br />Chris Swartz <br />Street Address <br />Street or Other Mailing Address <br />1811 West Second <br />Street, Suits 324 <br />City <br />State <br />Zip Code <br />City <br />State zip Code <br />Grand Island <br />NE 68803 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursalmil to the <br />revenue laws of the state of Nebraska. Notice is hereby liven that taxes including penalties and interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. Theca. taxes constitute. <br />a lien in the county for real and personal properly belongiul to the taxpayer or hereafter acquired. <br />cowiwv Tea <br />KIWMW <br />Tax Period <br />Data of <br />A,eMatnent <br />Amount of Tare <br />Penahy <br />f nhlneet <br />Additions <br />8alartttlaf <br />AwearnituR 4w <br />I neteoy Certlry that the Nebraska CeptrtMent" of. Rovanue has Compiler?,• with the revenue taws of the State of Nebraska In the deter- <br />q m(Qation of the amount shown,to :le due, and thb tanpayar'has failed to Fay the amount due after demand. If this M Jt c of State Tax <br />R. = jJY( Is an extension of an effktiva tltn. ii setves to cogfltlµt the Priority WY, tre state's Cnterest In the affected proparcy1L%r the taxpayer. <br />4 �} TaYna t N6 19' jet <br />r preparer's Signature Title t <br />♦f Rpypntip Anpnt Supervisor -- <br />+Authorized Signature Titli ! "Mate <br />FOR COUNTY OFFICIAL'S USE <br />NEWIAMA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink •Copy COUNTY OFFICE — Canary Copy <br />M A "ACM nor MS) DE Luc LIM toe "MM "ON) IS (ARE) To _BE;rum <br />s ll�rsr <br />alp n■aos. do <br />T119 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 />DEPARTMENT OF REVENUE. <br />_ GOLDENRODa TO BE KEPT BY THE REGISTER OF DEEDS. <br />BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE NO PRE — PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />w <br />ft <br />