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<br />I~'."'k' <br />dtPlrlmont <br />ofnrvanUfI <br />L.lln SIrI,1 Numbl:lf <br /> <br />Notice of State Tax Lien <br /> <br />88- 106777' <br /> <br />311 011 OB <br /> <br /> <br />-R..d Innructlon. on faVOr,. ,Ide <br />Dala Socllll So!:urlty Numbar <br /> <br />10-26-B3 <br /> <br />505-50-9386 <br /> <br />N.brlllka 1.0. No. Llln Flied With Spau.." SD~llll Sllcllrllv <br />2751380 Ha 11 ~ ~:~~::r ~:~lIedl Numbor <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />TAXPAVER NAME AND MAILING ADDRESS <br /> <br />Stale <br /> <br /> <br />v <br /> <br /> <br />d <br /> <br />Zip Code <br /> <br />City <br /> <br />Slato <br /> <br />Zip Code <br /> <br />Gra d Isla d <br /> <br />NE <br /> <br />6B801 <br /> <br />Grand Is 1 and <br /> <br />tiE <br /> <br />68801 <br /> <br />This Notice of Stote Tax Lien is issued by the Nebrnska [}epnrbuent of Revenue for unpaid taxes pursunnt 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 />II lien in the county for real nod personal property belonging to the taxpayer or hereafter acquired. <br /> <br />T.. <br />Category <br />Number <br /> <br />Tax Period <br /> <br />Data of <br />Assessmont <br /> <br />Amount of Tall: <br /> <br />Penalty <br /> <br />Int8rost <br /> <br />Additions <br /> <br />Balanca 01 <br />Assessment Due <br /> <br /> <br />76 1? <br /> <br />TOTAL <br /> <br /> <br />I hereby certify that Ih8 NebraSka Department of Rel/enuo has compiled wHIl tho rOllltnUe laws of the State of Nebra1ka In th!! deter. <br />mlnatlon of the amount s wn to be duo, ilnd tho la)Cpayer hilS jailod to PilY tho IImount due aUer demand. If this NotlCl!l of Slate TaM <br />Lien Is an 8Mt n of an e cllllo lien t serllos I conllnuo Iho prlorlly of tho 5tnlo's Interest In the affected property of the tSMpilyer. <br /> <br />T ;l~r;ll YJ:lr "pr\,;,..p C:::pJ:I,..;::lIl; c:t <br /> <br />1 ?_1 ?_AA <br /> <br />Date <br /> <br />R~~~nIlP Agpnt ~lIpprvic:nr <br />FOR COUNTY OFFICIAL'S USE <br /> <br />1 ?_1 ?_RR <br />Dal. <br /> <br />-NEaBAStcA DEPARTMENT OF REVENUE - W~ite end Goldenrod Copies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Conery Copy <br /> <br />4\ <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 />TIlE DOCUMENT(S) IS (ARE) ~! TO BE FORWARDED TO THE COUNTY CLERK. <br />DISTRIBUTION OF COPIES, <br /> <br />~: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT OF REVENUE. <br />GOLDENROD: TO BE KEPT BY THE REGISTER OF-DBEDS. <br /> <br />BILLING IS TO BE ONCE PER MONTlI ANO THERE WILL BE NO PRE- PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />