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<br />I <br /> <br />I~. nebraska <br />department <br />of re~enue <br />Lien SerIal Number <br /> <br />Notice of State Tax Lien <br /> <br />.88- <br /> <br />10,.915 <br /> <br />N'bra~ka I,D. No, <br /> <br />Lien Type <br />IE Orl91nal <br />o Renewal <br /> <br />County <br /> <br />Date <br /> <br />. Read Instruction, on reVerse sidll <br />SocIal security Number <br /> <br /> <br />4-15-88 <br /> <br />.5260051 <br /> <br />Lion Flied WllIl Sl>ouse's Social Secuflly <br />Ql Register 01 Deeds Number <br />Ha 11 0 county Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />l'AXPAYER NAME AND MAILING ADDRESS <br /> <br />BusIness Name <br /> <br />Name <br /> <br />lakeside Inn <br />Street Address <br /> <br />3205 S locust <br />City Slate <br />Grand Island. <br /> <br />Zip Code <br /> <br /> <br />Zip Code <br /> <br />NE <br /> <br />68801 <br /> <br />T 1 <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laws of the slate of Nebraska. Notice is hereby given that Iaxes including penalties and interest, which are <br />shown below t are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />alien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br /> <br />TllC Date of Balance of <br />Category Tax Period AssllSSmoot Amount of Tax Penalty Interest Additions Assessment Due <br />Number <br />01 2-4-88 546.46 16.90 29.55 592 91 <br />01 12-23-87 396.92 12 28 16 90 4 <br />01 2-4-88 363 44 11 24 11 1 385.83 <br /> <br /> <br /> <br /> <br /> <br />9 <br /> <br /> <br />319.57 <br /> <br /> <br /> <br /> <br />TOTAL <br /> <br />$ <br /> <br /> <br />~ i <br /> <br />I nereby certlfy tMt tno Nebra~k;\ Department of Revenue has compiled with the revenue law~ of the State ...: Nebraska In the deter- <br />mination of the amount shown to be due, and the taxpayer has failed to pay the amount due afte, demand. If this Notice of Stille Tal< <br />Lien Is an l~tenslon of an ellecllve II I serves to continue the priority of the state'. Intere.t In the affected property of the taxpayer. <br /> <br /> <br />'. <br /> <br />Rp.vp.nIJP 5pninr Agpnt <br />Title <br /> <br />4-15-AB <br />Dale <br /> <br />r~ <br /> <br />Revenue Agent Supp.rvisor <br />Tille <br /> <br />4-15-88 <br />Date <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />~~, - <br /> <br />NE8RASKA DEPARTMENT OF "EVENUE - White and Goldenrod Copies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Canary Copy <br />4-494-74 Rev. 7-81 <br />Supersedes 4-494-14 Rev, 5,80 <br /> <br />THE ATTACHED NOTICE(S} OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH <br />"THE REGISTER OF DEEDS. <br /> <br />~ <br /> <br />THEDOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERIC <br /> <br />DISTRIBUTION OF <br />WHITE: <br /> <br />GOLDENROD: <br /> <br />COPIES: <br /> <br />TO BE VALIDATED BY THE REGISTER OF DEEDS <br />DEPARTMENT OF RLVENUE. <br />TO BE KEPT BY THE REGISTER OF DEEDS. <br /> <br />AND RETURNED '1'0 THE <br /> <br />BILLING IS TO BE ONCE PER NONTH .;\ND THERE WILL BE NO PRE-P1WHENT OF FEES. <br />THANK YOU FOR YOUR COOPEfu'TION. <br /> <br />L <br />