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.r;febiask8 depa,tment . of revenue Notice of State Tax Lien 87- 107181 r LIen Serial Number Lien Type Date Social Security. Number IKl O,I91nol 12- 16-87 7112/249 o R,newal Nebraska I.D. No. County Lien Filed With Spouse's Social Security [Xl Register of Deeds Number 3631931 Hall o County Clerk I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Business Name Name Atchs of Grand Island. Inc. Atchs of Grand Island. Inc. Street Address Street or Other Mailing Address 3123 West Stollev Park Road 3123 West Sto11ev Park Road City State Zip Code City State Zip 'Code Grand Island NE 68801 Grand Island. NE 68801 . Read instructions on revorso side '., f.~ This Notice of State Tax Lien is issued by the Nehraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified abo\'e and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. I Tax Date of Balance of I Cet8llory Tax Period Amount of Tax Penalty I nte,est Additions Number Assessment Assessment Due 07-01-87 thru 01 09-30-87 11-9-87 3234.81 70.47 100.24 3405.52 07-01-86 thru 21 12-31-86 58.69 9.18 67.87 01-01-87 thru 21 06-30-87 389.99 82.73 44.26 516.98 - - TOTAL S 3 990.37 ..} ~,i " ,.-1. ;:; I hereby certify that th~ebraSka Department of Revenue has complied with the revenue laws of the State of Ne~raska in the deter~ mlnltion of t mount show to be due. and the t~~1aYer has failed to pay the amount due after demand_ If this Notice of State Tax Lien Is an .Slon of an elle live ~'en~,ves to;;; tinue the p,lo,lly ot the sl.te's Inte'est in the aflected p,ope,ty of the taxpaye,. . ~ '/L~ Revenue Agent 12-16-87 tUfe Title Date t , ;:1 1 ) ,~ Speci a 1 Agent 12-16-87 Date Tille FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Cene,y Copy 4.494,74 Rev. 7.81 Super,ede, 4.494.74 Rev. 5,80 - .".-.- THE ATTACHED NOTICE(S) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH THE REGISTER OF DEEDS. THE. DOCUMENT(S) IS (ARE) NOT TO BE FORI'lARDED TO THE COUNTY CLERIC. L DISTRIBUTION OF WHITE: GOLDENROD: COPIES: TO BE VALIDATED BY THE REGISTER OF DEEDS DEPARTMENT OF REVENUE. TO BE KEPT BY THE REGISTER OF DEEDS. AND RETURNED TO TilE DILLING IS TO BE ONCE PER MONTH lIND THERE I'lILL BE NO PRE-PlIJ'NENT OF FEES. THANK YOU FOR YOUR CQOPERATION. r/ ~ L