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Notice of State Tax Lien � <br />� as Read instructions an reverse side <br />� <br />� <br />; <br />� <br />` <br />tar <br />Warlike 1.0. NO. County Register t Dead$ Number <br />�..���. � <br />� <br />| \ <br />BUSINESS NAME AND LDCATION A�V�ORESS <br />Name <br />Businoss Name Petrol gg <br />Street Address 3 16_914 WOt-�iR*4YAO <br />3716 Old West State <br />i -tv !,late 1p code City 6B801 <br />68801 Grand-I an4,--- NE <br />Grand Island,_ <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 (if Nebraska. Notice is hereby given that taxes including penalties and interest, which are <br />shown below, are duie 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 tile taxpayer or liereafter acquired, <br />Balance of <br />Tax Clatti, of Amount of Tax Penalty Interest Assessment DUO <br />Numbes <br />21 103-31-85 -20-85 <br />1 18.20 1 11.43 278.68 <br />21 30-85 -851T 249.05 <br />~.."^',talc .1 rftt,rj,""~`="^.~ <br />lay oritfy Mat the f4ro-s"a tico'.Il State t31, <br />Revenue _�_qgq 11-6-85 <br />� <br />here ' Date <br />FOR COUNTY OFFICIAL'S USE <br />---- -- - - - coo*rvmw,� w"°'c"� <br />NuwmAorAn*/^nrm*wrnpREVENUE w^�°ds"m"�w,"p° ,^v,^,c� ^�cm° 1494 ,,,°/,/ <br />4 49.1 14 so <br />| | <br />