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4 <br />rd.-,e-.b,, <br />t enue <br />F <br />r <br />Notice of State Tax Lion <br />enoad instruetiomon f-we resolde <br />LlanSerial Number <br />lien TyPs <br />Date <br />Social Security INUM1641 -- <br />Irntpreat <br />Additions <br />9/07/464 <br />2g Original <br />Q Renewal <br />7 -31 -89 <br />507 - 54-4699 <br />��� :104002 <br />LI Filed witil <br />Spouse's Social Security <br />Nebraska I.Q. No. <br />County <br />Taeeieter <br />3534847 <br />Hall <br />of Deed <br />county-clerk <br />gbrg -62 -6743 <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Edmund-A. & Sharon <br />K. Brown <br />Street Address <br />Street or other Mailing Address <br />.P.O. Box 177 <br />City <br />Stato <br />Zip Code <br />City <br />Waod Rivers <br />State zip Code <br />NE 68883 <br />This Notice of State Tax Lien is Shoed by the Nebraalta Deputment of Revenue for unpaid taxes pursuant to the <br />m"atsle 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 abb,%e.and renuk xjapiaitl )i to demand. These taxes constitute. <br />a lies in the cositnty for real and personal property belonging to. the &Ypa a Wpv eafter acquired. <br />Tax <br />Tax Period <br />Dato of <br />Amount of Tax Penalty <br />Irntpreat <br />Additions <br />dalanbs of <br />Ase/eerrleht Due <br />NCstr � <br />-- -- -- <br />Assessment <br />° f hereby Certify that the Nebraska Dee <br />6m4natfon of the Npount S1 o to be due. <br />p:lert.is an ex a„n of an sif Iva lien It <br />$INN <br />`s S ature <br />.fora <br />CALJ <br />Jtuthorl2ed Signature <br />TOTAL $ 9z 61 <br />`t Of *eveaWei has Corn;WA wlth the revenue laws of the.State of Nebraska in the deter- <br />ne taxpayer Ras failed to ,yay the amount duo after demand. If thi ;MtIce of State Tax <br />to�eont:nue the priority of the state's interest In the affected property; of the taxpayer. <br />Taxpayers Service _ p Sal u .. <br />Title Date <br />Revenue Agent Supervisor-- 9 -31`U _1 <br />Title pate <br />FOR COUNTY OFFICIAL'S USE _ <br />NEMAiiCA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink Copy COUNTY OFFICE — Canary Copy <br />2M AVVCM f10rrI01(S) Or in ti=i tw aIa4), IS (ARE) TO BE FILED 0111' WITH <br />"S 30MULSM Cr r I - N . <br />THE DOM MENT(S) IS ( ARE) NOT TO BE FOJIM MED TO THS COUIi'IR' CLERK. <br />DISTRIBUTION OF COPIMs <br />r WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT nv PIZVptnr <br />GOLDE1RODs TO BE KEPT BY THE REGISTER OF DEEDS <br />BILLING It's TO BE ONCE PER MONTH AND THERE WILL BE NO PRE — PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. _ <br />