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R' <br />Notice of State Tax L6aa - - <br />atAa <br />tment <br />Lien Serial Nutntkrr j <br />Lien TyVe <br />91 Original <br />Oats <br />S <br />ederal Id. No. <br />Penalty <br />' <br />9/08/574 <br />❑ Renawal <br />8 -18 -89 <br />- <br />Asomment <br />09-404528 <br />Nebraska O. No. <br />L <br />County <br />V1104 <br />Lieu R11 With_ <br />Spouw's Social Security <br />2011549 <br />Hal I <br />EN Itesistrwr of Dwi�I <br />'lumbar <br />❑ Couunty cl-k <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />euatnoss Nam* <br />Name <br />Elliott All Heather Surfaces Inc <br />Strut Addreri <br />street or Other Mailing Address <br />2508 PiA eer Boulevard <br />City <br />State <br />ZIA Cqft <br />f>±itY state <br />Zip Code <br />" ji <br />'rand Island,. KE <br />68801 <br />- ,�.,r, . • <br />Iiit> a o6 Tscc U rzb is i l l !die , a r, t lff Revem, 4i for unpaid teases put ugv� , iii <br />►ws L 'L ssase :n? skai I pui is fix; r z�ti t t r ':� fiend ies and inLeres1ti .STS <br />t�tt iaatt:%tzltiw. � lie �r'I n t�tpaytx rsperifi a is� :Errs �.+gmid a�itfr.l3Cm od. '�di w taxes <br />a lie6 in the cant *.±roe real and penionai p r zpet y beton&g to the Liao,g�r;or <br />a>< <br />Catepry <br />Tai Period <br />Date of <br />Amount of Test <br />Penalty <br />Interest <br />Additions <br />Bnmen D <br />Ataaaattrtent tiw <br />Nwttbw <br />Asomment <br />t hereoy cerG+} Mat the Nebraska Oe;.a: i:TG15�' of Rayentle nas colnp.1*1 vr1;h the revenue taws of Me State of NOWaSka In me QI!' Va <br />min`at+un oft nlaunt shown tr. !pl. Q _r "e taxpayer nas falte(l to pay the itmaCrtt this after demand. it thlS NotiCeof State TUX <br />Lien Is an %;on of 804f, C ; +t. 4.r' :nr r To contm,.e :'ia onority of the state's ynfr'ast In the affected property of the to :payer- <br />w +� <br />s' <br />SIP � _ � Taxo ere Service Specialist 0 <br />r,��r g,_a.. TItIF Date <br />Revenue Agent Supervisor p -ZY -% <br />IAtlilotl d5lynatura ���' Title Date <br />FOR COUNTY OFFICIA4.9 USE <br />NEMASKA, DEPARTMENT OF REVENUE -• White and Goldenrod Copies TAXPAYER - Punk Copy COUNTY OFFICE -- Cenery Copy <br />A"ACM NWICS(A) G/ UX LIM (OR T113W l TION) IS (ARE) TO BE FILED O>W' IpX!'B <br />"a UNMOM cop awe. <br />Tkz •DCCUMM(S) IS (ARE) NOT TO BE TORWARD9S• Trv. TTIE COUNTY CLERK. <br />DISTAI$t?7C om OF Comm <br />1l tIt to RR V ALIDAITO HY TM P=391STER OF DEEDS AND RETUWW -V IV :I'h' <br />DEPARTMENT OF REVENUE. <br />GIUMENROD s TO BE VWT BY TTY i2P.GIS'PE OF 'DEWS. <br />DIMING I5 TO in CNCE PER fi mTH AND THVR'E WILL BE NO PRE— PAWttc Vr of FEES. <br />THANK YOU FOR YOUR'COOPERATION. <br />L <br />i •` <br />t? <br />s - <br />r <br />e <br />I <br />