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<br />I <br /> <br />'~el!ra'ka <br />department <br />of revenue <br /> <br />Notice of State Tax Lien <br /> <br />. Road instructions on reverse side <br /> <br />I <br /> <br />Lien Sttrlal Number Lien Type Date Social Security Number <br /> ~ Original sue 107108 <br />7/12/248 o Renewal 12-10-87 ,.-=. <br />Nebraska I.D. No. County Lien Flied With Spouse's Social Security <br /> [XI Register of Deeds Number <br />5260051 Hall o County Clerk <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADl I <br />Business Name Name <br />Lakeside Inn Teak Corp. <br />Street Address Street or Other Mailing Address <br />3205 S. Locust 7060 S. Yale, Ste 911 <br />City State Zip Code City State Zip code <br />Grand Island, NE 68802 Tulsa, OK 74136 <br /> <br />This NOlice of Slate Tax Lien is issued by Ihe Nebraska Department of Revenue for unpaid taxes pursuanl to the <br />revenue laws of the slate of Nebraska, Notice is hereby given that taxes including penalties and interest, which are <br />shown below. are due from the taxpayer specified abm'e and remain unpaid after demand. These taxes constitute <br />a lien in the county for real and personal property belonging 10 the taxpayer or hereafter acquired. <br /> <br />I Tax Data of Balance of I <br />Category Tax Period Amount of Tax Penalty Interest Additions <br />Number Assessment Assessment Dua <br /> 07-01-86 thru <br />01 09-30-87 3362.25 243.65 359.20 3965.10 <br /> 09-01-86 thru I <br />21 09-30-87 336.57 I 244.05 64.34 644.96 <br /> 07-01-86 thru <br />68 09-30-87 2492.69 232.87 268.10 2993.66 <br /> - <br /> - <br /> TOTAL S 7,603.72 <br /> <br /> <br /> <br /> <br />Special AQent <br />Title <br /> <br />12-10-87 <br />Date <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies <br /> <br />TAXPAYER - Ponk Copy <br /> <br />COUNTY OFFICE - Canary Copy <br /> <br />4.494.74 Rey. 7,81 <br />Supetsedes. 4+494.74 Rev. 5.80 <br /> <br /> <br />_1_'_--":__~~:\':>-"'.-_..'J.-'(l,~:,_ "-_'_;':'~::f)'_;'::, -,~-:~,:-"';"-'__._;<_-': nc.:_.:__:' -:: _ ',- -'c'-'- <br />~~;;~~~~rOF'TAXC~iENi(OR:TERMmATION) IS (ARE) TO BE FltED' ~ WITH' <br /> <br /> <br />,;:&~!i.~!~~~S:~~Mm w mE <br /> <br /> <br />~t~i~<.~~:ONCE.PER.~f'10NTH':AND:'THEJm',Wli.LBE NO PRE-PAYMENT OF FEES. <br />,h,Buf3Foa:YOUR COOPERATION.:' I ..' . '., " . <br />.--1..::..: <br /> <br /> <br />L <br /> <br />I <br /> <br />'1: <br /> <br /> <br />('-'....-....-...-. <br /> <br />~' ,i.~'"'.,~h,.,,',,. '. <br />... <br />~ <br />. ~ <br /> <br />r' :" <br />h- " <br /> <br />-.J <br />