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r <br />w <br />{ <br />i <br />V91 <br />r <br />Notice of State Tax Lion <br />• Reed instructions an reverse rite <br />Lion Serial Number <br />Lien Type <br />Date <br />Social Security Number <br />Psllalty <br />Interaa! <br />in Original <br />Hoene of <br />Asealeilsartt Dw <br />91071399 <br />p Renewal <br />7 -29 -89 <br />505- 78.7590 <br />89-ar• 104 015 93 <br />Nebraska 1.0. No. <br />County <br />Ll" Filtotl With <br />spouse's sores Security <br />3745:91 <br />Hall <br />In Reolster of Deed <br />umber <br />County Clerk <br />WSINESS NAME AND LOCATION ADDR483 <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business NsMu <br />Name <br />Carl L. Mayhem <br />Streat Address <br />Street or Other Milling Address <br />507 Plum Road <br />City <br />State <br />Zip Code <br />t 11.tf State Lip Code <br />.,.,rand Island, NE 68801. <br />This Notice of State Tax lien is i by the Nebraska Pepzartment of Revenue for unpaid taxes pursuant to the <br />revenue laws of the stale of Nebri{ :;Notice i- he eby giv �r that t xe incWd+ttE penalties and interest. whicYb arr" <br />shown below. are due born the tdto, iyer t�tsetlted above and remain uavaid of in.r demand. These taxes constitute <br />a lien in the county for red and per*ed pl y belonBttta to the taxpayer or hereafter acquired. <br />Tarr <br />CateEwy <br />N1rrnYat <br />Tax Period <br />Dmof <br />Asewtnent <br />11n1ouM of Tax <br />Psllalty <br />Interaa! <br />Additions <br />Hoene of <br />Asealeilsartt Dw <br />1 hereby certify that the 1WbraSka Department of Revenue has complied with the revenue laws of the State of Nebraska in the deter- <br />mination of the amount shqwn .to be due. and the taxpayer has failed to pay the amount due, after demand. If this Notice of State Tax <br />Lien Is an lion of an a tive II Wt serves continue the priority Of the state% lgtisr*frtthe affected property of the taxpayer. <br />e :i:, iiiiiiiiiiom;o TaYeayers Sarvice Sr�ecial�isi~_ Aa�'+& <br />Jim <br />ar! ature <br />Title Date <br />r <br />Revenue Agent . Supervisor' . P4:7& <br />t Signatu Title Date <br />�.' FOR COUNTY OFFICIAL'S USE; .. <br />r <br />i • <br />C <br />�" "te a rMeiMT OF AEV �Nir� —� ire andGoldeornd Copier_ _ _ TAXPAYER —Pink Copy COUNTY OFFICE — Cwwv Copy <br />i� IIOTICEiti� yI� (0it T�[DiATIGai) IS (ARE) TD BE FILED -.�. —;- <br />t� <br />or D=M. yr <br />i"R Docte>'B1T(S) IS (AM) NOT 20 BE FORWARDED TO THE COUNTY CLERK. <br />DISTRIBUTZdt of COPIESr <br />WHIZZ: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RST MED TO THE <br />DEPARTMENT OF REVENUE. <br />GOLDP RDD: TO BE KEPT BY THE mrsTeR OF•DSIDS. <br />BILL'M IS TO BE ONCE PER MONTH AND THERE WILL BE NO PRE - PAYMENT OF FEES. <br />MUK YOU FOR YOUR COOPERATION, <br />7 <br />' r <br />4L <br />_1 <br />