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t Notice of State Tax Lien •Read instruetiorts on rerrerse side LILien Serial Numbsr Lien Type 3 Original Date Soelal Security Number _T Amount of Tax Penalty 86- 104213 6/071762 ' J Renewal 7 -22 -86 508 -36 -9895 04 -01 -86 thru 04-30-86 Nebraska 1.0. No. County Lpea�n Fllart With SAousa -s Sociat Security ' 1 Register or Dead, Number 7-15-86 _128.81 5.00 s, 4470613 1s7s��,, Hall J Coun t y Clark Authorized Slgna, BUSINESS NAME AND LOCATION ADDRESS __— TAXPAYER NAME AND MAILING ADDRESS ^� Business Name Library Lounge i Name Geraldine R. ter - Street t Aoclress Serest or Other Marling Address __ T_ 2530 St. "Patrick _ 2815 Capitol Avenue City . State Zip Code City State Zip Code Grand Island, NE 68801 , Grand Island, NE 68801 This Notice of State Tat 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 Catetfory Number Tax Period Date of Assessment _T Amount of Tax Penalty Interest Additions Balance °f Assessment Due 01 04 -01 -86 thru 04-30-86 -15 -86 162.28 i 5.02 1 3.61 7 -22 -86 170.91 1 05 -01 -86 thru 05-31-86 7-15-86 _128.81 5.00 1.33 Special Agent 135.14 Authorized Slgna, a Title _ Date i i I 1 —_L TOTAL S 306.05 FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copes TAXPAYER -- Plnk Copy COUNTY OFFICE -- Canary Copy 4- 494 -74 Rev. 7 -81 Supersedes 4494.74 Rev, 5 -80 a 9 a El I hereby cer that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the deter- ' minatton of rttount sb�to be clue, and the taxpayer has failed to pay the amount Clue after demand. If this NotlCe Of State Tax Lien Is an trtflon of an eif five lien �_ serves to continue the priority of the state's interest in the affected property of the taxpayer. S1gD l Ci Revenue Agent 7 -22 -86 `ere Per's S atu Title Date Special Agent 7 -22 -86 Authorized Slgna, a Title _ Date FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copes TAXPAYER -- Plnk Copy COUNTY OFFICE -- Canary Copy 4- 494 -74 Rev. 7 -81 Supersedes 4494.74 Rev, 5 -80 a 9 a El