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Notice of State Tax Lien g 0028 Lion 5 Lion Serial Number Lien Type a Read inst ructions on reverse side 46 Date Social Security Number original 06 846 Q Renewal 6 -13 -85 Nebraska I.D. No. County Lien Filed With Spouses Social Security 45Ile Nall kJ Register of Dead Number JU County Clark RUStIYESS NAME AND LOCATION ADDRESS 1 Business Name TAXPAYER NAME AND MAILING ADDRESS Name South lacust Business Center Inc. strNtAddres: South Locust Business Center, Inc. 3235 South Locust Street or Other Mailing Address CItY State _ 3235 South Locust Grand Is 1 and ZIP Code City — NE 68801 state Zip Grand Island, NE 68801 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes revenue taws of the state of Nebraska. Notice is hereby Pursuant to the shown below, are due from the taxpayer specified above and rem `axes in penalties and interest, which are tic a n to the county for real and personal atn unpaid after se demand. The taxes constitute Property belonging to the taxpayer or hereafter acquired. Tax Period Date of Assessment Amount of Tax Penalty interest I Additions Balance of 1 -01 -85 th ru Assessment Due - 4 -30 -85 298.60 I 14.93 i - i ._ 5.04 318.57 1 ion Of certify that the Nebraska Department of Revenue has complied wiEh the revenue taws of TOTAL State ut Neb�as��ka in the deter - mination of the amount shown to be due, and the taxpayer has failed to �---- 318.57 Lien Is an extension of an effective lien it serves to continue the Pay a amount due after demand. I1 this Notice of State Tax e Priority of the state's interest "I the affected Property Of the taxpayer. ie •••� turs Revenue Agent 6 -13 -$5 Title Date orlred atura - -- __ SPeC1al Agent m _ A 6 -13 -85 Title FOR COUNTY OFFICIAL •c i tcc - -- -- - Date i NESRASKA DEPARTMENT OF REVENUE –White and Goldenrod Copes _ p TAXPAYER -- Pink Copy L L 9 COUNTY OFFICE- Canary Capy 4- 494 -74 Rev. 7•@?1 Supersedes 4- 494.74 Rev. 5 -bU Li 7 ti �