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r <br />Notice of State Tax Lien 85-- 004068 <br />ne6rask a <br />xtfnlnt *Read instructions on reverse side __ <br />of revenue — <br />Lian T gi Oate <br />Lien Serial Number Sbclal Security Nwnbor 1 <br />Original I — <br />5/08/136 R.nawal 8 -20 -65 1 506 -24 -1381_ <br />Nebraska I.D. No. County Lion Filoo wish Spouse's Social Sac uYlty <br />Re9lster of Deetls Number <br />4336534 Hall County Cletk 508 -54 -4209 ____ _ <br />BUSINESS NAME AND LOCATION ADDRESS , TAXPAYER NAME AND MAILING ADDRESS —� <br />Business Name rlanlc <br />Shirley & Jacks <br />------------- - - - - -- �- •�trae: (A 0111er flalhng Atl nrC55 <br />Street Acores% <br />3218 West Colleg _ -------------- - - - - -Z ��oe - - -- 3427171_ -_ Coital_ �rQ __- Sui.te-11- 1_---------- - - - - -- <br />f'C .y State Zip Cud. <br />city <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 ur hereafter acquired. <br />T Balance of <br />Tax I Date f <br />Category I Tax Period Assessment Amount of Tax Penalty _ -- - - -- Interest - -1 - -- Additions <br />Assessment Due <br />Number — Y�--r---- ---. -- _ <br />08 -01 -83 thru <br />— - -- — 745.71 — <br />01 '08 -31 -83 23 -83 I _ 530.40 23__34__: __191 97___' <br />106 -01 -84 thru <br />01 106 -30 -84 7 -25 -84 I _ .00 1 -6_13 11.00 _ 27.13 <br />07 -01 -84 thru - -- <br />01 107 -31 -84 �B -25 -84 OG __ - 1 -2.76 ----- - 1- 2_82.- - - - - - -_ -._ __ - - -- 25.58_ <br />— r <br />01 ;08 -31 -84 thru 9 -25 -84 _ ;41L 31 .00 52.66 <br />09 -01 -84 thru <br />I <br />01 109-30-84 - 42.5.46___ 9Q -_ _ _ 48.79_ -___ -- _474.25 <br />05 -01 -85 thru 1 <br />06 -01 -85 thru - 448._6_$_- 1.3..$$ ._ __- __4.31_ <br />_ 01 �06 -30 -85 J8_.7 -$ _ <br />Ol X05- 31 -85__ Z_$5 , <br />—� <br />- i._ 421.02. _. 13.02 4..20.. ' _ _- - t - ___ -_._ X3$_24__. <br />TOTAL S 2 647.75-- - <br />I hereby COINfy that ter! <br />•nal lrin. .1 the a, ,,Int <br />.1 an ...... .1 .� I t •. ,1 rateef �, <br />Wen tj an exlenif u.•+ CI`te r.LLnf�h�trr It Snr... r r rf ( ,,r .rrlV �1 DIY +e s. a.0 . ruler e5[ rrr .1 "ra dlfef.Se<I {'1f ,Pe.1y ut the ta.raaycr. <br />_Revenl�e-Agen <br />here PreParerrs a ura - - e <br />Q Special Agent 8 -20 85_ <br />Autnmlzetl Si atuee 11 gat _. <br />FOR CO %JN7Y OfFIC1Al'Sl1SE <br />NEBRASKA DEPARTMENT OF REVLNUi Yuba, 3110 Gndenrncf Cotl:l•s lAxPA.BR C, <br />� r � <br />_;(t11r4r ilF l-t 311311 <br />:, U•:.••tlr, J 3)4 11 ILr, � AU <br />Li <br />_J <br />7 <br />