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F <br />Isra*a Notice of State Tax Lien <br />10-di /Nttttent <br />Drat@ a Read instructions on reverse side <br />g. Lien Serial Number Lien Type Date Social Security Number <br />E [& Original <br />5/03/357 0 Renewal 3 -18 -85 507 -54 -4699 <br />Nebraska I.D. No. County Lien Filed With Spouse's Social Security 86. 001273 <br />3534847 Hall {a v Register or Dallas Number <br />® County Clark 505 -52 -6743 <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Brown's Repair Shop dmund A. & Sharon K. Brown <br />Street Aodress Street or Other Mailing Address <br />West Highway 30 ox 177 <br />City State Zia code City <br />State Zip <br />Wood (River, NE 68883 Doll River, NE 688E <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 />Category Tax Period Date of Amount of Tax <br />NYmbar �-�-�-�� Asea66ment Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Due <br />s -V r -64 EtI ru ---�. <br />121.79_ <br />O1 3 -31 -84 11 -15 -84 103.95 ! 5.00 <br />- - t ru <br />12.84 <br />91.72 <br />01 -30 -84 11 -15 -84 79,69 ' 5.00 <br />- t ru <br />7.03 <br />86.72 <br />01 1 -30 -84 11 -15 -84 82.36 ! -0- <br />— <br />! 4.36 <br />— — <br />I -- I <br />i <br />-° <br />'hereby certify that the Nebraska Denarrm -..e <br />TOTAL <br />--- <br />300 23 <br />- - • -•• — •,.- -„-- --n to D@ due, and the lax Dayar has tailed tt> paY the amount - -it-, �Y@rnanU fet"in 8 Notice in State T— <br />Lion % anan extension of on effective lien 11 L8rv88 to Continue the �(I my L!dt8'L :n!Cresf ii , @ }foc!@i Gthis No • c *.lie State Tar. <br />�gn a Revenue Agent <br />3_18_85 <br />— tparer's 51 v TIH® _�"'_"_- <br />Date <br />Authorized Mena a ____ - - Special Agent 3 -18 -85 <br />Title <br />NEBRASKA DEPARTMENT OF REVENUE - White and G(AdenInd Copies TAXPAYER P-11k N C ._._._- _....._. <br />npy COUNTY Or@ tCf_' t annry Cnov <br />.1 -e94 74 Ho", :.ea <br />!iubersnnes 4 .11d. 1d Haw. Sell <br />