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<br />I <br /> <br />Ir;:ebr"~ka <br />deparlment <br />of t1~~enuc <br />Lien Serial Number <br /> <br />Notice of State Tax Lien <br /> <br />8/04/787 <br /> <br />Lien Type <br />[XJ Original <br /> <br />o Renewal <br /> <br />County <br /> <br />Date <br /> <br />. Read instructions on ravern side <br />social Security Number <br /> <br />4-20-88 <br /> <br />505-44~6707 <br /> <br />88- 101990 <br /> <br />Nebrask. 1.0. No. <br /> <br />Lien Flied Wllh spouse's Social Security <br />)[] Register 01 DeedS Number <br />o County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Name <br /> <br />BuSI nen Name <br /> <br />Clly <br /> <br />Stale <br /> <br />Zip code <br /> <br /> <br />City <br /> <br />Zip Code <br /> <br />Slreet Addre" <br /> <br />688 8 <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of kevenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br /> <br />I Tax Date of BalanCil of I <br />Category Tax Period Assessment Amount of Tax Penalty Intarest Additions Assessment Due <br />Number <br /> 01-01-87 thru <br />01 O~-11-A7 122 57 15.85 24.40 162.82 <br />- <br /> TOTAL $ 1~? A? <br /> <br /> <br />I hert:by certify Ihat the NebraSka Oepartmenl 01 Revenue has compiled with the revenue laws of the State of Nebraska In the deter. <br />mlnat10n of the amount shown to be due. and Ihe laKPaye, has 'ailed to pay the amount due aftar demand. If l"ls Notice of Slate Ta" <br />LIen Is an nslon 01 an effeclive lien It serves 10 continue the priority of Ihe state's Interest In the affected property of the laxpayer. <br /> <br />RevpnllP Agpnt ~lIpe:rvi<:;nr <br />Title <br /> <br />4-?O-RR <br />Date <br /> <br />Revenue Agent Supervisor <br />Title <br /> <br />4-20-88 <br />Oato <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />-~.,. <br /> <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Cenery Copv <br /> <br />4-494,74 R.v. 7.81 <br />Supersede, 4.494-74 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 />THE DOCUMENT(S) IS (ARE) NOT TO BE FOR\'JARDED TO THE COUNTY CL.ERK. <br /> <br />DISTRIBUTION OF COPIES: <br /> <br />TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT ("If.' REVI,Nl1r.. <br />TO BE KEPT BY THE REGIS'rER OF DEEDS <br /> <br />BILLING IS TO BE ONCE PER MONTI! AND 'rHERE \HLI, BE NO PRE-PAYHENT OF FEES. <br /> <br />GOLDENROD: <br /> <br />WHITE: <br /> <br />TlWH<. YOU FOR YOUR COOPERlI'I'ION. <br /> <br />t <br /> <br />L <br />