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<br />lr;:eb..5k. <br />department <br />of revenue <br />L.len S.,lal Number <br /> <br />Notice of State Tax l.ien <br /> <br />88- <br /> <br />104416 <br /> <br />Lien Type <br />[E Original <br />o Renewal <br />Nebraska I,D. No. County Lien Flied With Spouse's Social Security <br />[]. Register of Deeds Number <br />1146165 Hall D County CI... <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />-Read instructions on revlIrsa ald. <br />Dale Social Security Number <br /> <br />TAXPAYER NAME ANO MAILING ADORESS <br /> <br />Stale <br /> <br /> <br />Zip CoClI! <br /> <br />Buslneu Name <br /> <br />Name <br /> <br />Me <br /> <br />Street Address <br /> <br />Cltv <br /> <br />Zip Code <br /> <br />Thi, NDtice Df State Tax Lien is issued by the Nebraska Department of Revenue fDr unpaid taxes pursuant to the <br />revenue laws Df the state of Nehraska. Notice is hereby given that tnxes including penalties and interest, which are <br />shown below. arc due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />B lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br /> <br />Te. oel.o' ealance 01 <br />C..-vory Tax Period Amount of Tax Penalty Int.fast Additions <br />Number AISnsman1 Assessment Due <br />01 4-25-88 1755.62 71,67 72.05 1 899.34 <br />01 ." 47,'] '. 45.00 16.08 <br />01 5 94 3.38 201 .30 <br /> I <br />21 l 50 74 -t' 39' 69" 105 17 <br />21 - '-2~~59 - i- 1.58 434 14 <br /> <br /> <br />sign <br />her. <br /> <br /> <br />TOTAL <br /> <br />s <br /> <br />5 <br /> <br />Taxpayers Service Specialist 8-10-88 <br />TlU. Dolle <br /> <br />Revenue Agent Supervisor 8-10-88 <br /> <br />Tille <br /> <br />C..llll <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />--~ <br /> <br />NEBRASKA OEPARTMENT OF REVENUE - Whll~ and Goldenrod Caple, <br /> <br />TAXPAYER. PInk COp'l' <br /> <br />COUNTY OFFICE - Canary Copy <br /> <br />THE ATTAClIIlD IlOTICE(SI OF TAX LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH <br />TItE REGISTER OF DEEDS. <br /> <br />THE DOCUMEXlT(S) IS (ARE) NOT TO BE FORWARDED ro THE COUnTY CLERK. <br /> <br />DISTRIBUTION OF COPIES: <br /> <br />GOLDENROD: <br /> <br />TO BE VALIDATED BY THE REGISTER OF' DEEDS AND RETURNED TO THE <br />DEPARTMENT or- "F.VF.N1 Jr . <br /> <br />TO BE KEPT BY THE REGISTER OF DEEDS <br /> <br />L <br /> <br />WHITE: <br /> <br />Bll.LING IS TO BE ONCE PER MONTH AND TIIERE WILL BE NO PRE-PAYMENT OF' FEES, <br />11mNK YOU FOR YOUR COOPERATION, <br /> <br />i <br /> <br />L <br />