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atka <br />RIP—Iment <br />Notice of State Tax Lien <br />• Neer ieetrualona on fv o aidrf <br />Lien Sarlet Nuf"W <br />t.Ifn Type <br />Date, <br />Soot►1 Security Number <br />Ponafty <br />Into=! <br />� anginal <br />Anowtilim Due <br />r��2M�/y��O <br />s7o�WV�3 <br />[� Rfnewal <br />7 -0589 <br />50579 -91l5 <br />■/� ■AK •�f /tQ <br />1x34 f V <br />Plabraeka t.[t. No. <br />Co%ml r <br />L" Filed W40 <br />404a"s• Seiew Satuf ty <br />22454450 <br />Hal l <br />IN Rylster of coma <br />W2736 <br />U County Clark <br />_ <br />L M NlNtati NAPA AND LOCATION ADDRIU <br />TAXPAYER NAIL AND MAILING AQ011ti1i1i <br />aueineee None, <br />Name, <br />Jay B. <br />and Carle itw.LJohnson <br />Street: ArMrete <br />Street or other Mailing Addlpsp <br />1216 East Fifth.'Street <br />city <br />Staff <br />Zia Calf <br />City <br />State zip code <br />Grand Island;' HE 68901 <br />This Notice of Sate Taus Lien is issued by the NebraAa Departmeat of Revinae for uWaid, toxcs pwursuant to the <br />wiles mt Iris of the sate of Nebrmka. Notice is hereby #man that texts indidilaa pensWes and intm.4, which aria <br />shown beitlw. are due from the taxpayer specified above and msiisk unpaid: a ter demand. These taxis constitute <br />al Hen in the cmisty tar rat and personal property bdogft to the taxpayer of herteafler acquired. <br />Tax <br />cowwv <br />Tax Period <br />Aatrinent nt <br />Amount of Tate <br />Ponafty <br />Into=! <br />Ari flans <br />Anowtilim Due <br />22. ; 12.31..97 thru (5..18.88 I 96 _ na ( 14.80 I 30.40 I I 141.20 <br />. 1 16.95 1 10 <br />TOTAL $ 507.68 <br />se, f hereby certify that the t%bfaske t?e,paftment of stavenue tin comglfad with the revenue laws „P the State, of Nabratka In tbede,tet- <br />i _. ion of in* amount snown to be due, and the taxpayers nos favor err pay the amount due after Demand. It this Notice of *Ska xTax �Oy'• <br />an 17[tanslon of an effeCtiye pen it serves to Continue trio pftotity of the state,'$ Interest in the affected property of the txrgiatyN. <br />Taxxnnrs Service Specialist <br />ture Title [late <br />' j Revenue Agent Supervisor ?—b -cam <br />AutinOrlied Slfeatule - Title Data <br />FOR C93UNTV OFFICIAL'SUSE <br />ft <br />NMI►AWA btlAatTNENT OF nEyemuE — white and Goidemod Copies TAXPAYER — Pink Copy COUNTY OFFICE — Carwy Copy .. <br />or us saw. 448.1 -1=�i 25 am) To BE 1I3.® <br />r T <br />Tlltt BOCIaI' "(S) IS (ARE) ! M TO HE FOR11ME01 TO THE COMM CLERK. � <br />DIS?RIUMION OF copies: <br />WITS: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETUPNL1) TO THE <br />DEPARTMOT OF REVEMM. <br />GOLDEN NOW TO BE KEPT BY 141E REGISTEER OF DEEDS. <br />BILLING I5 TO BE ONCE PER 1tiM AM THERE WILL BE NO PRE - PAYMENT OF FEES. <br />1 Twit" YOU FOR YOUR COOPCRAT10N. <br />C <br />