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i ro:'zrterfue <br />Notice of State Tax Lien <br />0 Read .. - m. <br />Lien Serial Number <br />Lien Type <br />Date <br />Number l Security N Social N <br />-'a umpo <br />no the ­oo - OT The State Of Nebraska in the dalax- <br />I has failed TO pay the amount due after demand. it this Notice of scot, Tax <br />. C�Unue the priority of "" store's i0r� in the affected property of " taXpWpW, <br />original <br />catesery <br />N.A. <br />Tax Period <br />1/03/448 ❑ Reno.ai <br />3-16-817 <br />Addl is, itich <br />saiwAm <br />Ne-3faska I.O. No. County <br />Lien Filed With <br />se Social <br />Spouse's social Security <br />JX Register Of Dead <br />Number <br />be <br />A,— C- <br />238SS" Hal 1 <br />Q County '. <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND NAILING ADOR <br />Business; Nam* <br />--- <br />Name <br />all 11�1 r- <br />Street Address <br />Street W Other Moiling Address; — <br />1 10-01-86 thru <br />P.O. Box 760 <br />City Star. <br />Zip cone <br />City State ZIP code <br />21 <br />Grand Island. NE' fiffini <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant 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 specirled above and remain unpaid after demand. These taxes constitute <br />a lien in the county for real and personal property belonging to the taxpayer or heregger acquired. <br />TAX <br />m notion of -h O.Ot <br />Lion is on a n of <br />10 <br />Sho.h. to be a.*. <br />an effeAl" 110" JPfar­ <br />no the ­oo - OT The State Of Nebraska in the dalax- <br />I has failed TO pay the amount due after demand. it this Notice of scot, Tax <br />. C�Unue the priority of "" store's i0r� in the affected property of " taXpWpW, <br />catesery <br />N.A. <br />Tax Period <br />Daft of <br />Assessment <br />Arnoiant of Tax <br />Addl is, itich <br />saiwAm <br />A,— C- <br />107-01-86 thru <br />21 <br />!09-30-86 <br />12-01-86 <br />182.40 <br />9.12 i 9.51 <br />201.03 <br />1 10-01-86 thru <br />f <br />21 <br />12-31-86 <br />01-31-87 <br />65.29 <br />1 .8.04 2.20 <br />75.53 <br />yyE <br />TOTAL <br />276.56 <br />"a ', Special Agent 3-/6-912 <br />Authorized Sjpnjuro Oab <br />FOR COUNTY OFFICtALS USE <br />RMCE(S) OF TAX I <br />(OR TERMIMiniDN) Is (AM) To BE FILED ONLY WIT8 <br />IMMLSM Or VMS. <br />THE DOCU<DD'T (S) IS (ARE) NOT TO BE FORWARDED To <br />THE COUNTY CLERK. <br />3DISMBIDTION OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND <br />RETURNED TO THE <br />DEPARTMENT OF REVENUE_ <br />1 7 GOLDENROD: TO BE KEPT By THE REGISTER OF DEEDS. <br />.�BILLM IS TO BE ONCE PER MONTH AND THERE WILL BE NO pRE_PAyNENT OF FEES. <br />—vnw ym VnIp VnrM �nnnxmrnv <br />C <br />0 <br />m notion of -h O.Ot <br />Lion is on a n of <br />10 <br />Sho.h. to be a.*. <br />an effeAl" 110" JPfar­ <br />no the ­oo - OT The State Of Nebraska in the dalax- <br />I has failed TO pay the amount due after demand. it this Notice of scot, Tax <br />. C�Unue the priority of "" store's i0r� in the affected property of " taXpWpW, <br />_Revenue Awnt <br />Date <br />"a ', Special Agent 3-/6-912 <br />Authorized Sjpnjuro Oab <br />FOR COUNTY OFFICtALS USE <br />RMCE(S) OF TAX I <br />(OR TERMIMiniDN) Is (AM) To BE FILED ONLY WIT8 <br />IMMLSM Or VMS. <br />THE DOCU<DD'T (S) IS (ARE) NOT TO BE FORWARDED To <br />THE COUNTY CLERK. <br />3DISMBIDTION OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND <br />RETURNED TO THE <br />DEPARTMENT OF REVENUE_ <br />1 7 GOLDENROD: TO BE KEPT By THE REGISTER OF DEEDS. <br />.�BILLM IS TO BE ONCE PER MONTH AND THERE WILL BE NO pRE_PAyNENT OF FEES. <br />—vnw ym VnIp VnrM �nnnxmrnv <br />C <br />0 <br />