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r <br />S <br />. <br />111offtHII'm **a rttirlt <br />Notice of State Tax Lion <br />pllead Jnaeruetiarse on nwraa aide <br />Lien Serial Number <br />Llan 1'yps <br />Date <br />Social Security Numaer <br />Penahy <br />89�"` i. �i a� + <br />9/07/400 <br />[] nenswal <br />7.29-89 <br />5-54 -2633 <br />Nebraska I.D. No. <br />County <br />Ltafl Filed With <br />spouse's Social Security <br />3745791 <br />Hall <br />® IttilWar of Doads <br />Nurnber <br />County Clark <br />BUSINESS NAME AND LOCATION ADORES <br />TAXPAYER NAMN AND MAILING ADDRESS <br />Business Name <br />Name <br />Street Address <br />Street or Other M*11ing Address <br />2-51-9 Seedlin Mil <br />City <br />State <br />Zip Code <br />City <br />State Zip Coda <br />Grand Island <br />NE 68801 <br />This Notice of State Tax Lien is issued by the Nebraska Depwtment of Rcy enue for unpaid taxes punuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes i u*ading penalties and interest, which are <br />shown below, are due from the taxpayer specified above and tentsia gvoiiiid after demand. 'these taxes constitute <br />alien is the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tau <br />Tau Period <br />Daa of <br />A hit <br />Amount of Tax <br />Penahy <br />nturwt <br />Addition <br />NG� r <br />f� <br />AMA Due <br />1 hereby certify that.tre Ngtraska Department of Revenue has compiled with the revenue laws of the State of Nebraska In the deter. <br />. r.pination of the amount , !t to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax <br />Clan Is an lion of an.e> ' flue N serves to ntinue the priority of the statir'S {nterset In the affected propastl�.laf the taxpayer. <br />SiA <br />Taxpayers Service Specialis%' -rah <br />re Title Date <br />. Revenue Agent Supervisor -f -� <br />Aftthorizad Signature Title Date <br />FOR COUNTY OFFICIAL'S USE <br />• '1Ve� <br />NEBRASKA DEPARTMENTOF REVENUE -Whits and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy <br />2M A22101M MOTICE(S) OF TAX "M (OR it Qt) 'IS (ARE) TO BE JPUM <br />Ift 111111101111M W wals. - -- <br />Tp$ DOCUMT(S) IS (ARE) NOT TO BE FORT MED TO THE COUNTY CLERK. <br />DIST'RIB1lTION OF COPIES: l <br />11HITEs TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT OF REVENUE. <br />GOLDINROD: TO BE KEPT BY THE REGISTER OR-DMiDS. <br />1• BILLING IS TO BE ONCE PER MMTH AND THERE WILL BE NO PRE - PAYMENT OF FEES. <br />THANK YOU FOR YOUR CCX)pERATION. ,✓ <br />_.-.l <br />