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ICZal lnan c ka Notice of State Tax Lien • os..t :...•..,.n..........w . rs. e:rte Lien Serial Number Lien Type Nate Socia Security Number Interest 1/04/517 ( L1 Original V Renewal 05- 01_ -81 i5'06-84-1166 1 n{2 �i oo� /.Il lrl Nebraska I.D. No. County Lien Filed With Spouse's Social Security 10 -01-80 thru 21 12 -31-80 04 -13-81 Register o1 Deeds Nund at I 6.36 1 21- 3296997 hall ❑ County Clerk BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS 1 Business Name Agillori#0 Signature Name Tom D. Erickson Tom D. Erickson _ Street Address Street or Other Mailing Address Rural Route 1 j Rural Route 1 City Slate Zip Code^ City State Zip Code Grand Island NE 68801 Grand Island NE 68801 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. Tax Catpory I ax "" "" I Number Date of Assessment Amount of Tax Penalty Interest Additions Balance of Assessment Due 0-01-80 thru 21 09 -30-80 _ 04 -13 -81 339.0.1 16.95 11.87 Lien is an extension of 367.83 10 -01-80 thru 21 12 -31-80 04 -13-81 317.19 15.86 I 6.36 1 Pr er's Signature 339.41 I s.. Manager Agillori#0 Signature � i I I I ' j I I I NEBRASKA DEPARTMENT OF REVENUE White and Goldenrod Copies TAXPAYER Pink Copy COUNTY OFFICE - Canary Copy •i 494 -14 Itev. 7 -a t !:upefsedes 4.494.74 Rev. SBU u J r• m L1S TOTAL I $ 704.24 1 hereby certify that the Nebraska Department of Revenue has compiled with the revenue laws of the State of Nebraska in the deter- mination of the amount shown to be due, and the taxpayer has failed to pay the amount due alter demand. If this Notice of State Tax Lien is an extension of an effective lien it Serves to COntinue Inc priority of -- a state's interest in the affected property of the taxpayer. - zip _ L� Revenue Agent / ti l q? rte �� Pr er's Signature f-, n title s.. Manager Agillori#0 Signature Title ate FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE White and Goldenrod Copies TAXPAYER Pink Copy COUNTY OFFICE - Canary Copy •i 494 -14 Itev. 7 -a t !:upefsedes 4.494.74 Rev. SBU u J r• m L1S