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' nehratka <br />tment - <br />of epenue <br />LIMSerlal Nambar <br />9/08/575_ <br />Nebraska 1.0. NO. <br />4911709 <br />SUS <br />autlnasL Name <br />Streat MO Ms <br />City <br />. 1 <br />Notice of State Tax Lien <br />•Read IrOful tioftf On ""M trills <br />rtreet or other Malling AddfMa <br />3404 hest 13th. suite 37 <br />.Ity slat <br />OV-! � 104527 <br />This Notice of State Tax Lien is issued by the Nebraska Departlnelst of Revenue for unod tatter pursuant to the <br />t+ePeaue burs of the state of Nebraska Nth b hereby e'en that faxes including penalties aaT'ki 0r1t§1..,whieh are <br />alirvie and tciraii unpaid after ddnmvL i�,� institute <br />below are due from. the taxpayer :fied ' <br />iyr,. tlreriter act <br />the county for read .a* PC50" p>r!rY <br />ln_lrwci 1 is <br />BaiwYim <br />aw Tat /K10d LiaU a• Al,- fntl fi Tax Penaitt i. Aim 1 t <br />t�at�Y Aaearttfe+w" • < <br />01-ot -89 thr t 1 . <br />:,��•.':' ffT."l_7it_ttQ l�t_tnr•R4 1.Q8�:P� j_r <br />, <br />TOTAL S 2 33A 6� <br />Cartlf V that the W{DHa ►b GlttuflM_nt of Revenue has comr,100 will, the revenue lairs of the state or fiB 9ra4ka 1n the dater - <br />iha amount shoran to LSe cl :*., Vf C the taxpayer has fa,l0d to Pay the amount due allot demand. If Ih,S Notiu Of Stata Tax <br />dans,o . of an eff IM:+ 10 Slaves' to continue 140 Pf,O"tY Of in* stale S 1nteraSl in the affeCted Property Of to taxpayer. <br />��_ RPVpnure SPILfi�r A Date !/ <br />Taw y^ <br />iignat <br />R L'I�ntta Aaen S�Qerw�i�,.._..._ <br />� pjte <br />1 Signature ---- -T- -__— Title _� �._..�...�..., <br />FOR CiZfXftTV OFFICIAL'S USE <br />0 <br />-� - COUNTY OFFICE - Con <br />wY COPY <br />#"gp isx^ DEPARTMENT OF REV ENOe -• White and Gold'nrod COPiea TAXPAYER - Pink COPY <br />I= A'l"Cum umcg(s) Or TAX <br />'S' =a ;' '� TARE) TO HE FILED OtfL.Y 1t►i'L'![ <br />THE DOI.'tsliM?(S}, X_� (ARE) liiri TO ilia 'MRWlrMM TO THE COUNTY CLERK. <br />ifiS1'RI=tM. (m O!f WPI"s <br />NHI'rbs TO HE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO '1111 <br />DEPARTMENT OF REVENUE. <br />CLfI.DPSIROtYs TO Bit KEPT BY THE REGISTER OF DEEDS. <br />SILLIN IS To Be ME PER W-24TH AND TIiERE WILL BE tt0 PRE- PAYMENT OF FEE5. <br />THANK YOU iOR YOUR COOPERATION. <br />t. <br />