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F 21M, -k., Notice of State Tax Lien •Read instructions On reverse tide 87— 101191 Lien serial Number Lien TyP- Oate Social --security shown below, are due from the taxpayer specified above and remain unpaid after demand. These farces constitute C O"ginal a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. I 2/02/478 [1Renewal 02 -17 -82 506 -46 -2692 spouse's social Seturity - Number NobrasW 1.0. No. County Lion Filed With JRegaster of Deep 3160 Hall ❑ county Clerk TAXPAYER NAME AND MAILING ADDRESS BUSINESS NAME AND LOCATION ADDRESS i2 -01 -81 thrt 436.63 2.74 j HYSmeS Name - Name - 10 -01 -81 ths4 236.00 1 12 -3I -81 01 -11 -8 223.37 11.17 1.46f Richard G. McMichael Street Adores. TOTAL S 2,221.66 - Street Pr Other Melling Address - - 1 hereby certify trial the Nebras" Department of Re.enue ?"Was" iO the diff r- mmation of the amount ShoWn to De due. ano Ina tatodyar riot * &,M` tC Day = a-'R At due after+ earillnd. If thif NOtil" of StaLe Tax 4215 Arizona Avenue City State Zip Code City SUte Zip Cede `. - asuthorind Signature ° —k 1 Grand Island NE. 68801 This Notice of State Tae Lien is issued by the Nebraska Department of Revenue for unpaid faxes Pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that takes including Penalties and interest, which are shown below, are due from the taxpayer specified above and remain unpaid after demand. These farces constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. Tax i } Bakwice of Cateabrq Tax Period Data Amount of Tax Pfasalty Interest AfMit ores qas aoarat - - Num6tr - 09 -01 -81 t1hru 3 01 -30 -81 i 01 -08 -8 410.93 13.67 1 17.18 1 ? 441.78 _09 -10 -41-81 thru ; _ 48{1.34 01 10 -31 -81 01 -08-8} 452.62 14 -00 13.72 11 -01 -81 thn 360.69 01 11 -30-81 01 -08 -8 343.73 10.63 6.33 i2 -01 -81 thrt 436.63 2.74 j 01 j 12 -31 -81 01-11 -8; 420.87 13.02 07 -01 -81 thr 866.22 21 09 -30 -81 1 01- -08 -82 223.37 33.51 9.34 10 -01 -81 ths4 236.00 1 12 -3I -81 01 -11 -8 223.37 11.17 1.46f f t TOTAL S 2,221.66 1 hereby certify trial the Nebras" Department of Re.enue ?"Was" iO the diff r- mmation of the amount ShoWn to De due. ano Ina tatodyar riot * &,M` tC Day = a-'R At due after+ earillnd. If thif NOtil" of StaLe Tax Lion is an extension of an effettiv 16 it Lewes to tontm" t?2 p --f or tha siatt's i.rterest f4 the aff-ctad P-Perty of Me, taws'an ar. sib �r � Revenue Agent 3 ° � �? A�. _ Data - ao` l rs C7� -'tie -here Manager 3—/—P7 `. - asuthorind Signature ° —k i - FOR COUNTY OFFICIALS USE - NEBRASKA DEPARTMENT OF REVENUE — White and Goldenrod Cmies TAXPAYER — Pink Copy COUNTY OFFICE — Canary COM - 4- 444-7& Rw_ 7-91 5uoersad -S 4-434 -74 Ren, "0 THE ll'leACM X=CB(S) (W TU LIEN (OR TERMINATION) IS (ARE) TO BE FILED ONLY WITH THE RMISTE1t or DimS. THE DOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO THE COUNTY CLERK. - I� DISTRIBUTION OF COPIES: t-- .: TO BE VALIDATED BY THE REGISTER OF .,.... S r..D s.civau= TOO TEE DEPARTMENT OF REVENUE. GOLDENROD; TO BE KEPT BY THE REGISTER OF DEEDS. BILLING IS TO BE ONCE PER MONTH AND THERE WILL BE NO PRE—PAYMXNT OF FEES. THANK YOU FOR YOUR COOPERATION,