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Notice of State Tax Lien <br />mart <br />•.ye,n� .ta.�d i.ut,..�trnr�on..,r.•s.�rr. <br />Numttq <br />Caen Type <br />f Date 5dcial Saco +ity Number I <br />I <br />ena <br />Penalty <br />eg OOrrginal <br />a <br />22 <br />I <br />05 -15 -8� 177.00 <br />8.85 <br />Renawal <br />County <br />07 -31 -86 1 505 -62 -2434 <br />Lien Filed With Spouse's Social Security —; <br />'. Register or Oeed .5,- 1 <br />86-f 0434 <br />Nebraska I.O. No. <br />11828080 <br />Hail <br />Lf County Clerk 506 -64 -0822 <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />• <br />j i I <br />Name <br />I � <br />nngth and /or <br />Pamelg Lindbloom <br />Street Address <br />Street or Other Malting Address <br />4120 North loth <br />Street <br />City <br />State <br />zip Code icily <br />state zip Code <br />Lincoln <br />NE 68521 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid takes pursuant to the <br />revenue laws of the state 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 />Tax <br />Category <br />Number <br />Tax Pariod <br />Date of i Amount of Tax <br />Ass Date i <br />I <br />ena <br />Penalty <br />Interest Additions 1— Balance of <br />�'�_ Assessment Due <br />22 <br />01 -01 -85 thru <br />12 -31 -85 <br />05 -15 -8� 177.00 <br />8.85 <br />7.26 ( j 193.11 <br />filing fee <br />—� <br />-- 001 10.00 <br />• <br />j i I <br />I � <br />TOTAL S 203.11 <br />I hereby certify that the Nebraska Department of Revenue has compiied with the revenue laws of the State of Nebraska :n the deter- <br />mination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice Of State Tax <br />Lien extension of an effective It— it serves to continue the priority of the state's interest in the affected property of tno taxpayer. <br />�) /1� <br />sign L, ,X e�GL� Revenue Agent ? y� <br />herefor's signs ure Title Date <br />Manager LLA <br />Afithorjfed Signature Title fDate,1 <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE — White and Goldenrod Copies TAXPAYER — Pink Copy <br />0 <br />COUNTY OFFICE — Canary Copy <br />4- 494.74 Rev, 7 -81 <br />Supersedes 4- 494 -74 Rev. 5 -80 <br />H <br />0 <br />J <br />