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M Notice of State Tax Lien T y Data 00kri" 1-17-M toa*"M" 4.0. no. County L+Wl rr4$*d With �Soouft's soc�i Security 101111 county cwk I BUMMM NAIVE AND "PCAMOIN ADDRESS TAXPAYER IMAIIIIE AND MAILMG ADDRESS Dick E. F. Gorge" SIMON ^0101,111" Street or oinar Vbilolg Address silo 6 Street i 518 G Street date Zia C ptyr state Cede icily civ WE 68826 Central City, NE 68826 centrul s Tbk Notioe of State Tax Lien 6 maned by the N tax pursum 4o he - . e*aska Department of Revenue for unpaid es t t t miengle haw's of the some of Nebraiska. Notice is herehi, given that axes including penalties and interest. which are dwwu below, we dye from the taxpayer specirted above and remain unpaid after demand. Theae taxes constitute a Sea in *e county for rod and personal property belonging to the taxpayer or hereafter acquired. Tax ca-l-Y Date of TAK PS"Od Amount of Tax Penalty I lnurmt i Elaimmis of Additions Ausumient Due 01 -01 -M thru i 10-31-83 141-25-831 102-82 5.00 2.09 109.91 z TOTAL 1 S 109.91 1 rWeoy cartily that The Nebraska DCP&r!Me-rl of Revenue "as comwieu with the revenue caws of the State Of Nebraska in the oeter- Miriation Of the Amount snown to be clue, and tne taxpayer has !ailed to pay The amount due Alter demand. If This Notire of State Ta. Li*n is an extainsion of an eft *7 iien it serves -,�, c 0 Minut the Priority Of -ne slate's interest in the affel.c� property of the taxpayer. Revenue Agent 3-5-86 Date A T. stye Agent 3-5-86 AutttatiZad "life Date FOR COUNTY OFFICIALS USE W-11RASKA DEPAFITMENT OF REVENUE.- While end Goldenrod Cop.&S TAXPAYEn - Pink Copy COUNTY OFFICE - Canary Copy 4- 49 & -76 A&y. 7-91 SuperSeoeS 4.49&.74 Rev. 5.80 46--a I a