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r <br />L <br />Notice of State Tax Lien <br />• w..a i..struetions on reverse stile <br />Lien Serial Number L <br />L -an 'Type D <br />Date sbc ial securty Numae* 1 <br />Original <br />- 11081140 R <br />Renewal 8 <br />8 -12 -85 _ <br />� ` <br />`� 00385 <br />NaWasW 1,0. No. C <br />County L <br />KI t <br />4W7W H <br />ttS� R <br />� f1 County Clerk <br />MM41dr= NAME AND LOCATION ADDRESS TAXPAYER N <br />Business Name Name <br />Grand Island Thrift Store, Inc. Grand Island Thrift Store. Inc <br />street AgdrKS Str-1 or other rNalllny AUclreSs <br />217 W. 2nd Street 217 W. 2nd Street _ <br />City State Zlp Cone (City <br />State Zip Cope <br />Grand Island, NE 68801 1 Grand Island, Nr 68801 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laves of the state of Nebraska. Notice is hereby given that taxes including penalties anduttemst, 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 aw hereafter acquired. <br />Tait <br />CataeorY j T. , z•iod i Date of ',., Amount of Tax Penalty 9nterest i Additions A Balance ent Due <br />{ Nutttbar � Ataecsment j <br />10 -01 -84 thru <br />01 '10 -31 -84 12 -5 -84 .00 5.06 .63 5.69 <br />11 -01 -84 thru 1 <br />01 11 -30-84 1 -9 -85 107.90 5.00 9.52 172-42 <br />'02 -01 -85 thru <br />01 102-28-85 11 851 18.13 5.00 .97 24.10 <br />03 -01 -85 thru �9 <br />01 iO3 -31 -85 6 -11 -8� _ 21-18 _.i1� —! _ -- ?9 n7 <br />104 -01 -85 thru <br />N <br />TOTAL S 203.52 <br />1 ttereby Certify that the Nebraska Department �t Revenue ha .'pmpilCU wl!h the revenge —5 ol the State Of NObraska in the clete!- <br />htlnation pt the amount zhb Wn to be clue• an6 the taxpayer has talliio tD pay "'It amount Cue alto aem.ho • :ri5 N—Ce o' State Tax <br />Lien is an extenstun of an eff-c.—. lien it serves '0 continue- Me pr-rlty 01 the state's rot—•! at Isere C�prnper: I GT the taxpayer <br />' Revenue ggQnt 8 -12 -85 <br />�� � _.. Tolle Dale <br />lip Special Agent 8-1 -85 <br />AW.nONSSa Si ure Title Date <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Coples TAXPAYER - Pmk Copy <br />COUNTY OFFICE -- Canary CDPV <br />4.44474 Rev. 7-0: <br />C' tP rsefles 4.44474 Rev. 5•ao <br />U <br />