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r f abraska tnle0,t Notice of State Tax Lien *Read instructions in reverse side Llan serial Number Lien Type Date Social Security Number c 85-- 00044 5/011140 E] Relnewal 1 -25 -85 503 -44 -8368 155.99 30.61 Nebraska I.D. No. County Lien Filed With Spouse's Social security j 11339 635 K] Register of Dead$ Number 1701 3633985 Hall C County Clark BUSINESS NAME AND LOCATION ADDRESS _ TAXPAYER NAME AND MAILING ADDRESS Business Name Name Tri State Transmission Clinton M. Onnen Street Address Street or Other Mailing Address 811 N. Munball 314 N. Darr Avenue City state _ zip Code city State zip code Grand Island, NE 68801 lGrand Island, NE 68801 This Notice of State Tax 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 Catowy Nurn Tax Period of Assessment Amount Amount of Tax Penalty Interest Additions t A pw COI -oi -80 thru 2 -31 -80 155.99 30.61 23 1 -01 -81 thru 30-81 j 11339 635 50 64 1701 i TOTAL S Sol An 1 hereby Certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska In the dater- mination of the amount snows to be due. and the taxpayer has failed to pay tree amount due after demand. If this Notice of State Tax Lion is an extension of an effective lien it serves to continuo Inc priority of the state's Interest in the affected property of the taxpayer. Sign tit TJ� RpvPntte Agent 1 -25 -85 �l�0 preparer's sign Title Data Special Agent 1 -25 -85 Authorized 14rti4 Title Data FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy 1,494 74 Rev, 7 a I 5 upersenas 4. 494.74 Rev. S -a6