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net►raska <br />adman! <br />F <br />Notice of State lax Lisa <br />. •iRaidInetruetionson reverse skia <br />(.ion Social Number <br />Lion Tyao <br />Pate <br />social Security Number <br />Penalty <br />Interest <br />Pn <br />Aeaettintant Ow <br />N <br />89'"!"' 103564 <br />89055060 <br />n nenrFwai <br />7_7-89 <br />508 -38 -1288 <br />Nebraskatl.Q. No. <br />County <br />Ltftiitoin Filled With <br />SPOUtie*iSOC4i SecUrltV <br />d3�162 <br />Hall <br />IN Register of Qaedi <br />Number <br />:] County Clerk <br />� 1111l1SINESS <br />_ <br />NAME AND LOCATION <br />ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />lousiness Name <br />��— <br />Name <br />Darryl Wllhelml <br />street Address <br />_ <br />^� <br />Street of Other Mailing Address <br />Kingswood Court Lot 6 <br />- <br />Willi <br />State <br />zip Code �~ <br />City State Zip Code <br />Grand Isla6d. NE 68801 <br />This Notice of State Tax Lien is issued by the Nebraska Depai:"t!tment of Re%enue for unpaid taxes pursuant to the <br />revenue laths of the state of Nebraska. Notice is hereby liven t5�>.it taxes including penaltks and interest, which arc <br />shown below, are due frrim the taripayer specified above and retrain unpaid after demand. Them taxes constitute <br />a lien in the.ewnty fit perxuaal property belonging to the tarpayet at hereafter acquired. <br />Tau <br />CaesprY <br />Tax ftll d <br />A Date <br />traMment <br />Amount of Tas <br />Penalty <br />Interest <br />Additions, <br />Aeaettintant Ow <br />N <br />,•, 1 herebV r?ert,fy that the Nebraska Department of Revenue has c ,.vgA,ed wit?t the revenue taws or the State of Nebraska in the deter- <br />• mission Of the amount shown to be due. and the taxpayer has faitaiz t.0 -pay the amount due after demand. It thfs Notice of Sttlte Tads <br />Lbrila an extension of 44.0 wive lash It serves to Continue the prrawtY Of the {tsto'e Interest In the affected propenY Of the taxpayer. <br />A if _ Revenue Senior Agent <br />hmp' eoiir ature rule Date <br />R n u <br />A ..Q4it Supervisor <br />� <br />Title p Date <br />Ythorited signature <br />FOR COUNTV OFFICIAL'S USE <br />NifIfMIAMA DIPARTMENTOF REVENUE - White and Goldenrod CO"s TAXPAYER - Pink Copy COUNTY OFFICE - ConarV COPY h <br />I= frW�01 ' (4) OF Tl11 LIM (OR T21111MIATION) IS (ARE) TO BE FILED MY 012 <br />it fli�G. <br />"M DOCUliIlr (S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK. <br />DISTRIMION OF COPIES: <br />W11ITEr TO BE VALIDATED BY THE REGISTER OF DEWS AND RETURNED TO THE <br />DEPARTMENT OF REVENUE. <br />GDWZNROD: TO BE KEPT BY THE REGISTER OF DEEDS. <br />BILLING IS TO BE ONCE PER MONTH AND MERE WILL BE HO FPT- PAYMF_NT CIF M.S. <br />rsualrK YM FOR Yf0Jn CO-OPEW TIOM. <br />i. <br />t <br />