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Notice of State Tax lien <br />nebraska <br />department <br />of revenue __ <br />*ROW lnstructi n <br />o son-- rowrwsids <br />sset'Serial.Number Lien Type Data T Sr.>tlai Security Number <br />r, r; 9i -� <br />X1/06/674 Renewal i 06/12/81 I 523-52-5474 <br />Nebraska I.D. No. Counh + Lien Filed Who j ;pousa sSoc 'security /N f' <br />i Tat Re9lstel <xfDeetls Number i 86- 10045'8 <br />21- 3770_0_60 ! Hall i ;r County Clark <br />-� BUSINESS NAME AND CATION ADDRESS <br />_. LO TAXPAYER NAME AND :MA141NG.ADDRESS <br />8u1,r:ets Name Name <br />Cox Construction. Inc. Gerald Cox <br />Street Ad. .­Ss Ss Street or Other Mailing Address <br />51`8 West Tenth Street 2215 West Tenth 'Street <br />City State zip Code City State zip Code <br />Grand Island NE 68801 Grand Island NE 68801 <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 Mate 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 />a lien in the county for real and personal: property belonging to the taxpayer or hereafter acquired. <br />F Tax <br />I Category Tax Period <br />i Number i <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />.Additions <br />$alance.of <br />Au plane f <br />( 07/01/80 thru <br />21 1 09/30/80 <br />! 10/01/80 thru <br />21 12/31/80 <br />02 09 8 <br />102/09,13. <br />2 532.•40 <br />40.00 <br />126.62 <br />I 2.00 <br />101.28 <br />1.00 <br />Manager <br />2,760.30 <br />— - — <br />43.00 <br />i <br />i <br />Title <br />1 <br />_ <br />i <br />Manager <br />ry•- <br />horl Signature <br />i 1 <br />I <br />I <br />_ <br />FOR COUNTY OFFICIAL'S USE <br />- --1 <br />TOTAL <br />$2,803.30 <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy <br />COUNTY OFFICE - Canary Copy <br />4.494.74 Rev. 7•83 <br />Supersedes 4.494.74 Rev. 5.90 <br />- - -- -- - -- --- 1 --- - - -••- -- e•.•••�•�••. •.• r.o vcn ue na> comp —C, with The revenue laws of the State of Nebraska in the deter- <br />minate • of the amount sho to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice <br />Lien i extension o1 an e 1 <br />flue lien it Selves t0 Continue the priority Of the state's <br />�! <br />of State Tax <br />Interest in the affected property of the taxpayer. <br />Manager <br />blerle <br />Signature <br />Title <br />_ <br />Date <br />Manager <br />ry•- <br />horl Signature <br />Title <br />GfClL + <br />Date <br />_ <br />FOR COUNTY OFFICIAL'S USE <br />- --1 <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy <br />COUNTY OFFICE - Canary Copy <br />4.494.74 Rev. 7•83 <br />Supersedes 4.494.74 Rev. 5.90 <br />