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.~ebril'k" departmenl of revenue Notice of State Tax Lien LlDn Serial Number Lien TYI;lO Date Social Security Number !Xl Onglnal 88- iG2534 8/05/843 o Renewal 5-10-88 210-38-0814 Neb~aska 1.0. r.. '. Caun1y Lum Fllod With Spouse's Social Security [j Regi,ter of Deed' Num:>er 4173600 Hall o County Clerk 493-56-7008 I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I tiuslnes5 Name Name Donald E. & Patricia s. Scroggs 51 reet Addross Street or Other Mailing Addross 312 Phesant Drive City Stale Zip Code City Slite Zip Code Grand 151 and, NE 68801 -Read instructiontl on rsvem side This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws 01 the state of Nebraska, Notice is hereby given that ta~es including penalties and interest, which are shown below. are due from the taxpayer specified above 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, Tax Category Number Tex Period Date of Assessment Amount of Tax Penelty Interest Additions BalanCll of AAft$ment Due 05-01-87 thru 4 TOTAL $ I hereby certtfy tt1.a~ the Nebraska Department of Revenue has complied with the revenue law$ of the State of Nebril5ka in the deter.. mjn.t1on of th~ amount sno to be due, and the ta ayer nas failed to pJly the amount due after demand. If this Notice of State T.ax Lien Is an ext on, of an elf Uve lien i erves to co t1nue the priority of the sut."s interest In the affected property of the bxpayar. TaYp~yer5 Service Specialist' ~~-~~ Title DAte ~:r.-/' -aY' RI>VI>n1l1> Agl>nt <;upl>rv; snr TltI. DAte FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE - White and Golden,od Copies TAXPAYER - Pink Copy COUNTY OFFICE - CenllrvCopy THE A'l"I'ACHED NOTICE (S) OF TAX LIEN (OR TER.~INATION) IS (ARE) TO BE FILED ~ ,<WITH THE REGISTER OF DEEDS. ~ THE pOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK. GOLDENROD: COPIES: TO BE VALIDATED BY THE REGISTER OF DEEDS DEPARTMENT OF REVENUE. TO BE KEPT BY THE REGISTER OF DEEDS. AND RETURNED TO THE DISTRIBUTION OF WHITE: BILLING IS TO BE ONCE PER l>10NTH AND THERE WILL BE NO PRE-p,'\nlENT OF FEES. THANK YOU FOR YOUR COOPERATION. " ' \0.