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r Y Notice of State Tax Lien ldf11 A Sment O? rftveove OAeed Irtzaructiens on serene side Lien Sarbl Number Lmn Typ® — �:Ja'e-- _ - -.�— 6/05/4 Re,swal —i7 5 -9 -86 1 508 -36 -9895 86-102418 Nebraska I.D. No, County — Lian Filed tin ispouzs'c SoCiAI SeCU+i;y 4470613 Hall (:i Register Deeds €Number County Cierk_ -- _ BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name ;Name Library Lounge dl Bottle Shop _Szer�ldlL�R� Baxter _ Street 3 S 281 -- _ !St5, Avenue - Capitol _ Address 2530 St. Patrick Avenue _ _ _ City State Zip C. City State Zip Code Grand Island, NE 68803 Grand Island NE 68801 This Notice of State Tax Lien is issued by the Nebraska Department et 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 Cat gory Number Tax Period T I - T -- �-- --r—'— Data of Amount of Tax Penalty Interest I Additions Assessment i I Balance of ! Assessment Due 02 -01 -86 thru , ; — ,. 01 02 -28 -86 (3 -25 -86 I 263.25 8.14 4.54_ j 275.93 Revenue Agent 5 -9 -86 _ rer's S' ra ��- Tlne { i Special Agent 5 -9 -86 - Authorizetl 11, ore Date - T - - - rt - - - -- - I TOTAL s 275.93 FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copies TAXPAYER -- Pink Copy COUNTY OFFICE -Canary Copy 4- 49474 Rev. 7.81 Supelsetles 4- 494.74 Rev. 5.80 I u 7F c t� 1 nefeby Certify that the Nebraska Department of Revenue ^.as complied with the revenue laws of the State of Nebraska in the dater - mindtion Oft mount Srtdwn to be due, and the taxpayer has fa l led to pay '.he amount due after demand. If this Notice of State Tax ,. Lien IS an nSion b f }eC Live lien { ves to Coat roue the pfiority of the state'S interest in the affected property of the taxpayer. Si n i1 Revenue Agent 5 -9 -86 f h e« rer's S' ra ��- Tlne Date Special Agent 5 -9 -86 - Authorizetl 11, ore T.tie Date FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copies TAXPAYER -- Pink Copy COUNTY OFFICE -Canary Copy 4- 49474 Rev. 7.81 Supelsetles 4- 494.74 Rev. 5.80 I u 7F c t�