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f� asks <br />trrsen }. <br />Notice of State Tax Lien <br />•Read instructions on reverse side <br />1­I401 sales Number <br />Lien Typo <br />[@ original <br />Date <br />Social Security Number <br />85— 002257 <br />5/05/699 <br />L3 Renewal <br />5 -8 -85 <br />Nam9n <br />Awssment <br />--------- <br />Nebrat" I.A. No. <br />County <br />Lien Filed With <br />Spouse's Social <br />Security <br />`04 -0 84 thru� t <br />18 Register of Deed <br />Number <br />gAe�L <br />4280466 <br />uu'' <br />Hall <br />!.N County Clark <br />20_70 <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Neme <br />Name <br />Flash Advertising Silk Screen Print <br />Flash Advertising Silk Screen Print <br />Street Andress <br />Street or Other haaWng Address <br />2326 N. Broadwell <br />2326_ N._Broad'well__ <br />_ _ _ _ <br />City State Zip Cod! <br />Clty State Zip COde <br />Grand island, NE 68801 <br />Grand Island, NE 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 />Catpory <br />Date n9 <br />Tex Period ( Amount of Tax <br />Penalty <br />Interest <br />Additions <br />+ Balance of j <br />Nam9n <br />Awssment <br />--------- <br />' <br />- - - -- <br />Assessment Duo <br />�� <br />`04 -0 84 thru� t <br />, <br />01 <br />106 -30-84 7- 20 -84_ i 188.06 x5,82 <br />20_70 <br />( 214.58 <br />-0 <br />6741-44 thru <br />^ <br />t-- <br />—; <br />-- <br />01 <br />'09 -30 -84 111 -22 -84 <br />165.85 <br />_00_ -_ <br />12.40 <br />-- <br />178.25 _ <br />10 -01 -84 thru1 <br />I <br />1 <br />—01 <br />12 -31 -84 2- 18- 85185.91__ <br />-- _- <br />5__75 -__ <br />_--- 7,- 14-- <br />- <br />199,E <br />-'' <br />� ' <br />+I <br />I <br />I <br />i <br />TOTAL ____J. S T 591.83 _ <br />' rtef aby CaftJly Ines tr:rt NBbrasha f /eparl •J €:r• „r IaTrei'::r. :e2 n.. JC ye.•l:e law: �.,! !hn `,late 01 NOUt asks In ilte del BF <br />rJ Sl nU fs A} IP�a 3:r�1Unt if: C1Wn t!. tln <l :.d. a�J.J t'r �• X11 r .� ; :.Ayr � . ��� +,I : sit,, Ir I.1 , r4,,tj,. r SIa1C Ta <br />Lr Bn Is an extenflon of an a110Ct lra Ilea o f.el tle5 I, ct;nl fJnP th- :� -11ty -1 the 6tate'l'IM.1"I In the tlflaC led Lfope:ty of the taxpayer. <br />S411 R< -------- <br />fe prepares'! atuJe '? :t:a ()ate <br />F Spec i a 1 __Agent - - -' -- z,at5 -8 -85. _ -- - -' <br />• �etnr�a -lase sturo <br />FOR COUNTY AFF IC IAL'S USE <br />NEBRASKA DEPARTMENT OFuEVENUE wnlFean< }fnldanrJx }CJ -„>mA TAXPAYER I':,,A(.;ny I.SIt�ry�fVf1FF1('�} (�;anHJYI�r.SJY <br />.b agJ ?1 fa J^v !a7 <br />i�por i8neb a.•t4a -/a Noy jr,.l <br />119 <br />• aa� <br />