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<br />I <br /> <br />I~ebra~ka <br />department <br />01 revenue <br /> <br />Notice of State Tax Lien <br /> <br />Lien Serial Numbor Lion Type Date Social Security Number <br />8/04/725 IXI Original 4-19-88 508-94-0933 88- 101991 <br />o Rel''1ewa~ <br />Nobraska 1.0. No. County Lien Filed WIlt1 Spouse's Social Securlty <br /> [}l Roglster of Doeds Nurnber <br />5291895 Hall o County Clerk <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS 1 <br />Business Name Nama <br />Prairie Pizza Larrv J. Patterson <br />Stroot Addross Slreat Or Oll1er Mailing Address <br />313 N. Webster 662 Faidlev Place. Ant. #5 <br />Clly Sl.te Zip Code eily Slate .:Zlp Code <br />Red Cloud, NE 68970 Grand Island. NE 68803 <br /> <br />. Read instructions on reverse side <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 state of Nebraska, Notice is hereby given thal 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 Ba'alll:a of I <br />Category Tax Period Assessment Amount of Tax Penalty Interest Additions Assessment DUD <br />Number <br /> 12-01-86 thru <br />01 12-31-86 4-6-87 167.82 28.97 196.79 <br /> 01-01-87 thru <br />01 01-31-87 4-6-87 330.58 10.22 52.87 393.67 <br /> 02-01-87 thru <br />01 02-28-87 4-6-87 107 . 18 7.18 16.03 1 30. 39 <br /> 04-01-87 thru <br />01 04-30-87 9-2-87 170.99 5.29 21. 57 197.85 <br /> 05-01-87 thru <br />01 05-31-87 9-2-87 74.92 5.00 8.62 88.54 <br /> - <br /> TOTAL $ 1.007.24 <br /> <br /> <br /> <br />e~ <br /> <br />D.la <br /> <br /> <br />Revenue Agent Supervisor <br />Title <br /> <br />4-19-88 <br /> <br />0.10 <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />, <br /> <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod COllies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE ~ Canary Copy <br />4.494-74 Rev. 7.8l <br />. C......,.,r......rI...r " <'1.0.\ 1::t. DJlou G.tJlt1._ <br /> <br />THE A~~ACHED NOTICE(S) OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH <br />THE.REGISTER OF DEEDS. <br /> <br />~ <br /> <br />THE DOCUMENT(S) IS (ARE) NOT TO DE FORWARDED TO THE COUNTY CLERK. <br /> <br />DISTRIBUTION OF COPIES: <br /> <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS !\NO RETURNED TO THE <br />DEPARTMENT OF RL~ENUE. <br />GOLDENROD: TO BE KEPT BY THE REGISTER OF DEEDS. <br /> <br />BILLING IS TO BE ONCE PER ~IONTfI J\ND THERE WILL BE NO PRE- P/\Y~IENT OF' !~EEs. <br /> <br />THANK YOU FOR YOUR COOPERA'I'ION. <br /> <br />L <br />