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\ ✓ <br /> � � � � <br /> � � �� � ca c� cn <br /> Ca O D � <br /> � � � � � <br /> � p� � m Z � � � � <br /> -< Q <br /> � o� ° T' � Ly <br /> X1 -rt ("� � Z w-+t N <br /> �1 � ° �, z rn � <br /> � rn n w O y <br /> �' 99-1oss9� N � � � � z <br /> � cr� � � 3 <br /> /^ D r� � <br /> ��� � ti:....� � <br /> � 417 �- +� <br /> � � � o <br /> �' �� . . <br /> �r Notice of State Tax Lien �� <br /> nsbraska � <br /> d�partm�nt <br /> o}nvsnw <br /> PLEASE DO NOT WRITE IN THIS SPACE <br /> T�RMINATION OF STATE TAX E.IEt� <br /> INDIVIDUAL INCnME TAX <br /> IF YOU INt1UIRE ABOUT YOUR <br /> ACCOUNTt REFER TO TH�Sc NUMB�RS: <br /> SOC. SEC. N0. G695$8170 <br /> N�tsR. IDENT. N0. 39435�36 <br /> SPOUSE SOC. SEC. N0. <br /> TAXABLE Y�AFi 1957 t�ARK � DEiNAIO <br /> LIEN N0. 9828�a002 73399 WETHERFZ�LL DR <br /> LIEN RELEA5E N0. 95�1460550 NEST CH�STER �DN 45069 <br /> COUNTY <br /> DATE OF NOTICE 05/26%9,99 <br /> INS7RU�iENT N0. �q;�;��301� <br /> PURSUAN7 tD TH� R,EVENUE LANS 0� THE S�'AI'E DF NEBRASKA� N07ICE IS <br /> NER�BY GIVE�V BY THE NEBRASKA D�PAR�'A7EPJT OF REVEAIUE THAT THE <br /> STATE TAX LIEN WHICH HAS BEEN DULY FILE� AGAIIdST TH� AB�V� NAMED <br /> TAXPAYER FOR INDIVIDt1AL INCO�i�t TAX�S IS TgRMINAT�D� <br /> I H�R�t�Y C�R7IFY THAT THE lVEBRASKA DFPAt�7MEMT OF REV�NUE HAS COMPLIED <br /> WITH TH� REVENUE LAWS 0� TH� STATE 0� NESRASiCA Ii� ;NE DETERMINATION OF <br /> THI5 i'�RMINATION. <br /> . �.�-.r�:�... ...�::.:� ......... ..����1.��.,.... <br /> PREPARER�S SIGNATUR� TI � DAT� <br /> .�`r���.. . �.... (/ � �0�0/�/9 <br /> • � • •i •��` i��• •������•i`••�f�f <br /> AUTHORIZE� SIGNATURE TTLE G�� DATE <br /> NEBRASKA DEPARTMENT OF REVENUE—White and Canary Copies TAXPAYER—Pink Copy COUNTY—Goldenrod Copy <br /> Printed with soy ink on recyded paper <br /> 7-145•79 Rev.10-95 Supersedes 7-145-79 Rev.S-91 <br />