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b;n ebrs ka <br />11revenue <br />1 <br />Notice of State Tax Lien <br />•Read instructions on reveres tide <br />Lien Serial Number <br />Lien Type <br />Dale <br />Social Security Numhar <br />Penalty <br />Interest <br />5/02/236 <br />M Original <br />Renewal <br />2 -15 -85 <br />506 -20 =4855 <br />11 -30 -84 <br />85- 0008'76 <br />Nebraska I.O. No. <br />County <br />L�lipen Fliatl With <br />Spouse's Social Security <br />01 <br />Hall <br />!d Register of Deeds <br />Number <br />5.00 <br />1.11 <br />4558251 <br />61.65 <br />County Clark <br />291-18-2387 <br />02 -11 -85 <br />82.33 <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />1 87.99 <br />21 <br />Name <br />02 -11 -85 <br />130.60 <br />17.44 <br />8.53 <br />Irene & Walter Kopystynsky <br />d /b /a I.K. Booter <br />Street Address <br />Street or Other Milling Address <br />Pioneer Plaza <br />411 No. Grace <br />City <br />State <br />Zip Code <br />City <br />State Zip Code <br />Columbus <br />Nebraska <br />68601 <br />Grand Island <br />Nebraska 68801 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes 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 />C~y <br />Numbq <br />Tax Period <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Asap Balance t of <br />Due <br />1 <br />08 -01 -84 thru <br />10 -31 -84 <br />11 -30 -84 <br />.02 <br />15.00 <br />4.40 <br />19.42 <br />01 <br />- ru <br />11 -30-84 <br />02 -11 -85 <br />55.54 <br />5.00 <br />1.11 <br />61.65 <br />01 <br />- ru <br />12 -31 -84 <br />02 -11 -85 <br />82.33 <br />5.00 <br />.66 <br />1 87.99 <br />21 <br />01-01-84 ru <br />X09 -30 -84 <br />02 -11 -85 <br />130.60 <br />17.44 <br />8.53 <br />156.57 <br />TOTAL 1 $ 325.63 <br />1 hereby certify that the Nebraska Oepartment of Revenue has compiled with the revenue laws of the State of Nebraska in 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 is an extension of an effective lien It serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />Revenue Agent 2 -15-85 <br />x'ssisnaturs Susan M Title Data <br />Special Agent 2 -15-85 <br />law signature James V. Cleveland Title ®_ Date <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE - Wlliteand Goldenrod Copies TAXPAYER - Pink Copy <br />1 <br />COUNTY OFFICE Canary Copy <br />4.494 -14 Rev. r.al <br />Superaeries 4- 494.74 Rev. 5,ao <br />U <br />K <br />