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Notice of State Tax Lien <br />e Read instructions on reverse aide <br />Lion Sartal Number <br />Lien Type - - <br />hate - <br />Social Security Number <br />- - <br />Interest <br />C Original <br />Assessment Dus <br />01 <br />11 -01 -83 thru <br />11-30-83 <br />6/05/460 <br />9 Renewal <br />5 -15 -86 <br />505 -80 -1817 <br />— <br />� 14 345 <br />Nebraska I.D. No. <br />County <br />Filed with <br />Security <br />240.72 <br />Lien <br />Register <br />Spouse's Social <br />Number <br />284.66 <br />2632802- <br />Hall <br />County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Dusineaa. Name <br />- <br />Nam, ._. . <br />Ravenna Heating 5 P1umbin2 Inc. <br />Street Address <br />E75 <br />Street oY Other Marlin- Address <br />511 Padua <br />511 Padua <br />City <br />State Zip Code <br />City State Zip Code <br />Ravenna, <br />NE 68869 <br />1 Ravenna. NE 68869 <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 />Mown below, are due from the taxpayer specified 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 hereafter acquired, <br />Tu <br />NC <br />Tax Period <br />Date of <br />Aesssrrlent <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Assessment Dus <br />01 <br />11 -01 -83 thru <br />11-30-83 <br />142.59 <br />8.66 <br />56.37 <br />207.62 <br />01 <br />12 -01 -83 thru <br />12-11-83 <br />-30-84 <br />240.72 <br />43.94 <br />284.66 <br />1 -01 -84 thru <br />01-31-84 <br />3-06-84 <br />E75 <br />378.35 <br />2 -01 -84 thru <br />01 <br />02-29-84 <br />- - <br />274.47 <br />3 -01 -84 thru <br />_ <br />03--n--84- <br />- <br />184.69 <br />1 <br />1 27.28 <br />211.97 <br />04-01-84 thru <br />- <br />- <br />260.13 <br />oi <br />5 -01 -84 thru <br />- - <br />L19-A4 <br />18,9Z <br />TOTAL <br />$ 1 636 13 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the dater- <br />, minatlon of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax <br />Lien Is an extension of an effective lien It serves to continue the priority of the state's Interest in the affected property of the taxpayer. <br />•U� ��%) Revenue Agent ��3 %%' 7 <br />Preps er' atur Title Date <br />ills 4 Special Agent <br />- Authorized S#Iature tv Title Date <br />FOR COUNTY OFFICIAL'S USE <br />Aft RRA$KA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink Copy COUNTY OFFICE — Canary Copy <br />4.494 -74 Rev, 7.81 <br />Supersedes 4.494.74 Rev, 5.80 <br />I <br />I <br />