i� --- -
<br /> ���., � .. . 6 _ ,s.ap :n'xt-.f_ ,�. . : -- —-- . - .� —' — — _ ._.._
<br /> p ` � � s
<br /> rt.. - <
<br /> —�}r - _ = --�--^-�d.:.`:...�';'-—��'''t='� � - . _ _ =- — - .�=�: --
<br /> ., . �cc � �- ' - t- ��a�-. �......yi;Y , , ' _w r i� - — � . --- � .�'—.�—� ' -
<br /> — -�—��Y� _'c , c ' . \ . _ :. ' ` ` ,. . - �,
<br /> .� ��• .� � � .
<br /> -- � � � � . ���� <:.
<br /> .� . .
<br /> -�� - -- ` ` TERMINA?�OM OF STwTE TAX �IEN g�..�i43078 �_. �
<br /> - � � _ INDIYtWAL IIiCOM� TA�it �
<br /> „:= - - __-__ __- . - _ _..- -- . ._ . . - - - - • - - - -- - -- - -- -,--�-
<br /> `' �. ''` �F VOiLYHWiI$E_`A�it1Z YOUR � _-
<br /> - � ___�
<br /> - - - _-_ --._ -_-:_-- __ _ -�-
<br /> --�- .-.___ � - —
<br /> j' ��1��.�:€�� ACCOIIIlTs .itE�"r�lt��O fii�SE iiUIfHER3� �.
<br /> — }�_r`��}K--:. . . - _ --- -- -
<br /> �,}��'- � . • SOC. SEC• NQ. ��SQ�$08738 JERA� N � SHARZ � MIRTM =-
<br /> ��Y�-�`" IiEeR� It1ENT• MD. . , _i4s83 - � �i� ra�r�:�.
<br /> �,. , , . fl'�3: . . .. . . . --
<br /> : %�` c ' :B�L�SE: SQ�C+ �S,€�.i AIC�e:.r'i0jT8.8�'22Q 3�:• 13" .,. � �NE �� � --
<br /> �'' '`�r�''�s`s Y T'IIJ�/M�1u�w '�� •s:�-,-�....1�4 � � _ 6it�tia lSLAlI�i:,:' �1��v -- -
<br /> ,� �'F' .- :. .. � ./� _ . L,��• r _ . . . �C7C'�, '-.
<br /> : � �` d •:d�i►;. !�1.�.�Y�` ., .T�•
<br /> : :`;"°:`'�F� � . �3 �
<br /> � ;s��r� ���t� ���`l��'��.`��� ��� _ _ t � -;' ..��'� ` :�..- --
<br /> �: `� .� �,� HAtil. .�-
<br /> � �� --r-------
<br /> $ „'� `t Y� �f,��7��'�'!:4�;�.�` � t: a3I34l93 . . _°:�'�'�
<br /> , ;;,.�;�; ;�. f_ �O�T�:1� Nf�'It'c . - �.
<br /> ;�,1�,5�; _ _. . IMSTRUMENT Ni3• /T.� •S�f.YYf _ , � :��m��--
<br /> _ ,;:,�.., . ,; t �. . �� .��.t.,�.-
<br />� � , .: . � MlRSUANi T� THE REVENUB. I.AMS OF 1HE STATE DF .NEI3AASKA� NOT�CE IS � � , ';. '_. !�,
<br /> - � f, • - ` MEREdM GIY�H SY 7HE [rEfRA.4KA DEPARTNENT OF R�YEMUE TilAT T11E �, `
<br />. - - � STATE T� I.I�M MMICI! HAS �ikEN I�ULY_ FIi.EO AGAINST.TME�A�OYE NAMEG - -
<br /> 'y � ' � TAX�AY�eA FOIi I!lDI1tIDNA1. �NCONE �AIt�S I5 T�itMINA'iEO• - , . � ' .. . --
<br /> " --�-_�;v ,. '. .. . , .. �:• "" •_ . • ._
<br /> � ' " � �� � .. I NERE�Y C@A7ZfY THAT rH� N�aRASKR De�ARTq�NT i1f 11EYENUE M11S 6�LIED • �- ,___
<br /> � �°. ,. ',.-,��--
<br /> - _ . . � .; _ MITH �1� R�Y£NU@ LAIiS OF THE TAT� (�h N RASKA iN TME OBTHftM�Mlltt011 Eip � . ..._.�r �°�••-
<br /> . - � . `� ' YHIS T aM� ' � . . _ .:_
<br /> • ��-%=-
<br /> .'�, ..t . E.�._ . .. _
<br /> � '�`� _,. _,�.�
<br /> ... . . ,�I�/�� -
<br /> � � � ;�} '.. ... .. .....Y..lG.GS«�• � � . �'� °�.
<br /> .c Y�' . .. „ `',...r.�
<br /> � , PARER�S 5IClIATUR� OAT� ? . -: . _.
<br /> �;_� , ; ';_;,:.;_Y,+`�
<br /> . �� ;��
<br /> ; , � , ��,�G :�;-;t:�r,��:,:.
<br /> . _ _ . � . i,� , '
<br /> -� / a.;s�t. W
<br /> • ��� •�����.���s�ii.• > �'r'r a�i',.;,-.
<br /> � �i��• •• s �•� •r:�?n;��''Y�ir.,,__.
<br /> c�� AUTNORIZ� I�NA�URE ITLE DA7F i. :;�`�;r,d4`;`h��'.��i�-
<br /> }5'� �'<<�'='
<br /> -r�. . • � .l,', ��•ii��`j1)Pf���ti'.y.
<br /> f �� :' `!:l`',n"�.'.�;�r,�t t.�.
<br /> . :f�s u:•. .. 5
<br /> � �S t15E �'. .=°f:;�"; i� �
<br /> � F�7R CONN'f 1f OFFICIAi. • . =:_K���1t5��� ;,:
<br /> : :: � �;;.,��;,,rf.;,�,.;;
<br /> - ,,�;, . ,_: 7 tj,t:�;�.:•
<br /> .;,,� �. � {:-:. �,.,�;�1i,;',:J��> �'�..s�',
<br /> ri�.�.'� � � � • . � - . . . � . :Mq���;ifJt�t�:.ss,,'7•'f. . .��
<br /> '' �'., �
<br /> ..,/i`. � ` "1 . . • 1,:;.� 1 tY ; `'+�` `�
<br /> •, .� . ,,�, , . . � �` 4 1 j.
<br /> ._ ,, � � ' . . ,. 1 �� ��. ,�,�„�,.
<br /> �;� � fr . .. . . � : `.'+�:Y,i�'��;,r',<< .
<br /> i}
<br /> , ,,��� . . � �► � ��� � �� Z � , S,<<t,,r�. �.
<br /> "y5✓ e :i•� � , . � � . ' �1 a:. � ' �/ � �, �y C � � ;';;;t ,�s� j;
<br /> ' '. .i7 �Ifl� .�t .. ,. '�.; � ' . . ' .. � '3�, � -=� �, � ~� � C� - " ., �',`� •
<br /> !r:i�t ' �'-� "'� � � ^ ' E , ; :,:L;"' . , �
<br /> .. ''' � ,:'�'� r, - H ' .. • �� �y �� � . � _''�`r�;:.;.#Y7� �
<br /> �y", ... � �� + � ,41�;};'.�'�
<br /> �� � �I� '•�4�;.�`'_��
<br /> .�.� �• � . � � �� , "n �.y '�'�'I�i �^ . .l,`�:: .
<br /> `'�1 '.x '4� . , . �� � ' : ' `'� Z r� W Y„''iCi'' ; '.
<br /> .y` `�� .,. '. � .. ' . � F i , � � �6 �, r n �,ti�f,�� ., �.
<br /> . . •=� r . , r (� DC� '� :Z4.,, 7�:/•'+;:
<br /> . �}`' ,' . . _ , �. , �` � . , . . � 1� ^ — �"'r" ��i,�rt••0�'
<br /> . . p' .�J '��. . .:,� ...�:b �
<br /> V C)� . - . � �� ��c','�� , i;:?�",'',
<br /> :�;' * � N N < � � ir.:. «'_�j.`. y,:;;�,: ' •
<br /> . ' • : ; � . �f. ..r„ .;:
<br /> %�� � w�'�.'''� ; 4�� � ..
<br /> . � +.'• ...... ,i` . r,.'�. �i;:.�i� .
<br /> ':; . . , �� , � !l�IUIfUAOE�AlliYflf10F1EY�N118�i�IC'0 �'��:,i�,:�. � �
<br /> ,,':' , ,
<br /> `� • Nywi+w.a�ra���ow+�•�o�,ww•aawa�rwaaM.o�.�.na�.�.r.o w��n�e�oarna.a.�.Maa�rn�d.yari.n�r: �t
<br /> awno.mnn�w.+a�ooa�iaabra�r� �,':':;
<br />. . ��.�:. � a�raswww�.r►K�rs�ne.rat�esra�wa�ewten� � �","
<br /> �.. .. ISi041,N—t11of1?li77� G11A1pMLAlp—f�l�BTa . tICMm!!u►pl—AON�'M�� f' �.
<br /> : ., • OIWq�(1�l�,�N 1101/�OLK—N�l!lt41� lCQ�iSIRf—Aal�'f�0 ' .
<br /> . .. I��iK�110EPMTA�IENTOFiIEVENtlE—IM�lbitdCanuY��apN Tl�l�AYER—PkikCap�► COE1�iiY—GoldlrrodCaOlr !
<br /> , :.tN.r�w.s�1 ` .
<br /> , . li�lOMilA1/�7lIY�t fM �
<br /> `� ..
<br /> . ,iy;� '��.jj,�r. . .� .� . . . . � . - .`+y•.i , , .
<br /> a� [ �r � �t(1l��`f��� � -� 'I.9�T.� : , . - � i
<br /> .`.d.,%��'•�` i,,f 'I�f,ti�,f�.ifi��'^'�'',i:'I � � .i� � r,'{ F.,,;�_! � � r � ,): _'
<br /> ,i�r, ti Lsl� �f�yry+�- `�i,E`;��,r�f" i y_ t'�. .-1 � -��4��3� � - . . . , . , r, .irt''•';It'.,.��
<br /> .��` ..d {; �Sa�,} }1`�f[1{;'��'���r;{�T''�',`'�f'' �i:•r1 �.r}�i Ll; ��'i �.,,{*i i:. , '�.�� � . •
<br /> �� t: PS 51t3•t��;���r ��� �.s��:r.f�.� di�ii'� `,`sa �� } .':n;?',i, i. ,1' ' �. . � - , n� .�li��.
<br /> f .t �,,i r r T 1 ,.'1! ,�1�, �', i, ,i•} . . ; , �!.
<br /> '��:,.r4 .�h'�l�f�•._.�. .�°_ r=;��:.t::`;',-r�;,ir�-1'-?it�.1�(.�f f.�.L'.1�'Il.':�O:i'JJ,t;:i:"r�- - .�' ` � • � - -- 7'
<br /> . �-.`-=-f� �;�.'s_ �d;_T -�.✓zi.;��r�-.,._:.�.._t..:�,aa(�.rl�'�f.�i? '•,'i:;r. r`__ .- '-'----- . . '-' -- "---'- '—-- . -_."---' -----'- -' . . -'- -----_'--._.-'-.,
<br /> .. "iJ _ (..Yi, _,
<br /> ' Y! 1 t.�..•.!i' 1�.1.;1� I 5 . 1tj. �/ •'� �'✓ ..
<br /> S�i / '_ . "(;'!':. '�r�� �. . 1 1. _ 1 .
<br /> i .'y� . � ii f• .t ..r`:: - . • ' . . . . ''
<br /> _� . . �. ... ... ,. � , ' 'i „ '. . . . _.. � . ' ` ' _
<br /> .. . ... � .
<br /> � _ . .. ._ . i . _ . . ..
<br /> ' � �
<br /> �
<br /> � . `
<br /> s � � - ``
<br /> . .e -� . . ' �.a.rE . _ _ .
<br /> •
<br />
|