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� r � <br /> � cci <br /> � � � <br /> � o ..-� <br /> � �,�., z -n-, CO <br /> �� o c � ` � i� v <br /> � �J � -'' c�v <br /> �� �' � � <br /> � ° �.� = m ~' � <br /> � ;� c� � r". � � � <br /> � � � (n � D ;,,� � <br /> � N � <br /> � � � ` � � � <br /> � � � � � <br /> � � � � <br /> w � Notice of State Tax Lien <br /> � �Ir <br /> � �.� 99- sc�4��1 �-� <br />� of nv�nw q <br /> � PLEASE DO NOT WRITE IN THIS SPACE �'� <br /> " 1 This Notice of State Tax L.ien is issued by the Nebraska Department of <br /> Revenue for unpaid taxes pursuant to the revenue Iaws of the state of <br /> Nebraska. Notice is hereby given that taxes including penalties and <br /> interest, which are shown below, are due from the taxpayer speciRed <br /> below and remain unpaid after demand. These taxes constitute a lien in <br /> the county for real and personal property belonging to the taxpayer or <br /> hereafter acquired. <br /> Nebraska Identification Number Lien Fled V1lrth �i1�lFederal I.D.Number Spouse's Social Security Number <br /> 7 6 3 2 2 0 7 �Register of Deeds ❑co��,cy cie� ryi�_o?G���9 <br /> Lien Serial Number Lien Type Date of Lien Courriy <br /> 9/0 5/3 5 2 �origina� ❑Continuation ❑ Corrected 0 5—0 4-19 9 9 HALL <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAIUNG ADDRESS <br /> Business Name Name <br /> MULTI-NIEDICAL, LLC <br /> Street Address Street or Other Mailing Address <br /> 3016 WEST FAIDLEY AVErIUE <br /> City State Zip Code City State Trp Code <br /> GRAND ISLAND NE 68803 <br /> T� Date ot <br /> Category Tax Perlod Amount of Tax Penalty Interest Addkions Be�ance of <br /> Number '��^�t Assessment Due <br /> 04-01-97— <br /> 21 06-30-97 02-11-99 . 4339. 81 1256.9 764.66 6361. 45 <br /> O1—01-98— <br /> 21 03-31-98 02-04-99 159. 80 12.9 14.54 187. 33 <br /> TOTAL $ 6548. 7£3 <br /> 1 hereby certify that the Nebraska Departrnent of Revenue has complied with the revenue laws of the State of Nebraska in the determination <br /> of the amount shown to be due,and the taxpayer has failed to pay the amouM due after demand. If this Notice of State Tax Lien is an extension of <br /> an effective lien,it serves to continue the prioriry of the shate's ir�ter 'n the affected property of the taxpayer. <br /> si9� � �� �3��n� <br /> here ePar s Signatur itle � � Date Telephone No. <br /> �- <br /> > % s �' <br /> orized g re Tiqe 8 <br /> NEBRA DEPARTMENT OF REVENUE- hite and Goldenrod Copies TAXPAYER-Pink Copy COUNTY OFFICE-Canary Copy <br /> ��0°"'°��d�°°' a-asa�a aev.iass supersedes a-asa-�a aev.s-ss <br />