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�� 93341'7 <br /> ;�� . <br /> 99 11177� � ����� <br /> �r� �'�C ��J'r <br /> . ��s^�� �'.� 1��i����s-�0 <br /> ScCif ST,'�T� . <br /> � Notice af State Tax Lien <br /> �� <br /> � <br /> �� <br /> �f nrww� <br /> PLEASE DO NOT IMAtTE lN TtiIS SPACE + <br /> 'Tbts Notice oF State Tax I.�en is issued by the Nebreslsa Department of <br /> Reve�ue for uapaid taxes pursuant to the ,revenue iaws oP tbe state of <br /> Pdebraslra. Notice is hereby given that taxes iin¢luding penalt�es and <br /> inperest, wbich ar+e shorwn belaw, a� due Crum the taxpaysr specified <br /> below and t�ematn unpaid atter demaad. These t�xes cunstitnte a lieo in <br /> tbe oounty for real and persoual p�uperty beioaging to the taxpayer or <br /> hereaRer acquired. <br /> NebraSka edenElFqtion Numq9r lien Fled YYM Social Se�axiry ar Federal I.i7.Number Spousa's Sociel 3ecurity NumDer � <br /> 8 0 6 rl6 2 9 �7 R�;�cer ot p�,as [7 Counry G�nc ��,-1511�$7 <br /> 9�.�a.Iz� 6 2 �*]Origina� ❑c'•rxienuaoon Q Comecteo �11 u2$�19 9 9 � HAI,L <br /> �Y 6USINESS NAME AND LOCA170N ADaF#ESS TA?�AYER NAME AND MAIUNG ADDRESS <br /> Buslneas Nam9 {ygmp <br /> DYVE�2SZF'IED C)PTILr1L GoNCEPTS INC <br /> ���r�� S7aet or Qlt�r MiliNnq AtlGtess <br /> __ PQ 80X 39372 <br /> c�j s�ee zp coaA cny smee zp coae <br /> LOU�SVILT,E KY �1�233 <br /> � Date oi Balance ot <br /> Catsgory Tax Periad Amount of Tax p�eny Dnbnst Addkions <br /> Numbe� ��� As3e88n1ent Due <br /> Q4—01-97— <br /> 21 I2-31-97 11-28-99� 2175. 00 543. 75 40�.52 37.25_._27 <br /> Q1�01-9$— � <br /> 2�. ., a <br /> oi�47:-99— <br /> �eturn to: <br /> STATE rJF NE�RASi(A <br /> QEPAFtTM�NT OF REVENUE <br /> 1891 WE5T2NQ ST 8TE 46G <br /> c�RAN4 ISLANO NE 68803 <br /> TUTAL � 9348,5� <br /> i here�CerU�r thgt the NeDraska D9p2t►�►lent oT Revenue has Complfed wttl�ih6 revenue laws of Ihe S�te pf Neptesk2 irl th9 d9t9�r11iM1�tion <br /> ot me amourn shohm to Da tlue,a�nC the(�epayoi nas tailed to pay me armurrt dua aR�er Ge�ria��, H th�s Notice ot^atate Ta�r Lien is an e�csension o� <br /> an ett uen�it serves to r-0Rtln e pfiDfiiy at Gtie smie s Interegt In the�feCte4 poperty W 7�e caxDaYer. <br /> $��n ` ' [ /.� 00-5�5' (3 R�).��'.�'Gc�73r <br /> here � �S � T �=a T9t9phOns Np, � <br /> } � � .� <br /> vii2etl Slgrs�ture T 08ce <br /> NF@RASKA bEPARTMQtvT OF R�NV�-YVh�le and GaiCenrod Copies TAXPAYER-Pfnk Copy COUNTY�FF{CE-Ganary Gopy <br /> �""'°"'�:.:�'d'" NOI�IItIQ �':�'ll t•!!�BZ :ZZ E6, bZ .'a3Q��,.s.� <br />