<br />;~i J..
<br />l<;:~~~ f
<br />\ ,:','...-.00,
<br />"~~
<br />, ,...~-
<br />
<br />, .
<br />
<br />, .-.aI'
<br />-~~-:l
<br />, l
<br />
<br />Di,' ....."'-J........--.....
<br />r
<br />_w ,.NaBee,o' Federal Tu Uen Under Intemal Revenue LaWI
<br />..... ~
<br />
<br />".~....",~__o-.
<br />
<br />.....
<br />
<br />25
<br />.
<br />
<br />.,."'",ff
<br />a.aha,' .. ~'''~IJ''~!:::
<br />
<br />: i.-.s. ,.
<br />
<br />478803055
<br />
<br />f AI,~.-"IIII'.......... "e- aD........................ Code,
<br />,; =.~4::..-== =~=-=r.:;
<br />... ____ ..... ....... . r...... ~ 1'heNIcn. tIiiIrj II a"'"
<br />IIn ... of.. UnIted...... on 11.........- IIid .......10 ........, ............
<br />to," ......,... .. .... ....... 01 ..... ...... .... IiIIIIJonIiI ...........
<br />~.......... --..... .., '
<br />I ,,' ,
<br />...... of T.-payer
<br />LORB. . K CRARLBNB ~RORKODSGARO
<br />
<br />88-
<br />
<br />102177
<br />
<br />..\
<br />
<br />'.
<br />
<br />..,
<br />
<br />AeIIdInce
<br />
<br />1022 II. CBARLBS
<br />GRAND ISLAMO, M. 68801
<br />
<br />...,
<br />
<br />.-,
<br />
<br />" iMPORTANT RELEASE INFORMATION: WIth rapect 10 NCh ......iMnt .11tId below. unl...
<br />r.ouo. of '"n I. ,.nled by the date lllven In column (I), thll "otto. ~I. on the dl)' following
<br />IUOII date, ..... u . oertlflclte of ....... u deft'*' In lAC 113215(1).
<br />
<br />-',
<br />
<br />, KInd of Tu
<br />, (a)
<br />1040
<br />
<br />; Tu Pertod
<br />IndIcI
<br />(b)
<br />12-31-86
<br />
<br />IdenUfrInI Number
<br />, (~)
<br />503-64-5650
<br />
<br />Dm of
<br />AII.amenl
<br />(d)
<br />6-22-87
<br />
<br />....1 D., 'or
<br />Reftllng
<br />(e)
<br />7-22-93
<br />
<br />Unpelcl .e1.nce
<br />of Autumenl
<br />(I)
<br />6624.S4
<br />
<br />"
<br />
<br />'\
<br />
<br />.f. : J
<br />
<br />t,
<br />
<br />,
<br />
<br />'I
<br />;) .."" ,"',
<br />1'1 ",,'
<br />:1 'It'
<br />,
<br />
<br />~ ,. ...',
<br />_~, L:;' '1' :, 'r
<br />
<br />."4. 'Jo' .'"
<br />h; .1,;,;;. 't.""
<br />
<br />-I- ,;_'
<br />
<br />"I.. t'- '!I''' ~..
<br />
<br />..( '"
<br />
<br />~ q.'
<br />
<br />"';;1' _ . ~l
<br />
<br />--
<br />
<br />fJtace of RUng
<br />
<br />Re9i8ter of Deeds
<br />, Rall county
<br />Grand Island, HS 68801
<br />
<br />TolII
<br />
<br />.
<br />
<br />6624.84
<br />
<br />,'.....
<br />
<br />blls ,. .
<br />r' r.; -~ ~; ~ n) ,
<br />!J
<br />
<br />"\
<br />
<br />_\' "l1,'
<br />
<br />,";
<br />
<br />o.aha, HI:
<br />
<br />, on this,
<br />
<br />'~ ~,I..1l()tIce ,wu p,....red and signed at
<br />
<br />_} .1 r~'
<br />
<br />-':
<br />
<br />: the
<br />:J
<br />
<br />
<br />Revenue Officer
<br />
<br />- ; SIgnIIu..
<br />
<br />Ace -Phone-1-B
<br />-0000
<br />CIIO'n: Cert\flC:Ite of ofllcer.wtllorind by ... to taka M1knowtqnlen.. I. not _llaIlo the validIty 01 Notlca of Fadera' Tu Ilan
<br />AlII. Rue. 71...... 1871 . 2 C.B. 408)
<br />
<br />Form 8II(Y) (Raw, 12-11)
<br />
<br />. "';
<br />. "; .~
<br />
<br />- '~.g
<br />:''-,:;,:i..
<br />
<br />Part 1 . Kept B)' RKOrcllng Office
<br />
|