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<br />asks <br />dl~partmmt <br />Notice of S#ate Tax Lien <br />•Re.d insentctinns bn rsreru side <br />UMf Serial NumbK Lisn Type Dit1 Social Security Number <br /> Original <br />~ . <br />3 Ol 925 n <br />n <br />IJ Renewil 1-20-83 508-54-4668 <br />NsbrasW 1.9. No. County Lisn Fllea with Spouse's Social Security } "; <br />, <br />8 <br />~ <br /> ~] Register of Degaz~NUmber ~j Ai <br />3.~..~~ ~ ~ <br />1875426 Hal l ~ County Clerk <br />$USENESB NAMf AND LOCATION ADORESS TAXPAYER NAME AND MAILING ADDRESS <br />6usmeu Name <br />R_ Jakubowski <br />Terry rvame <br />Terry R. Jakubowski <br />_ <br />Strpt Address street or Other Malling Aaaress <br />n 903 South Claussen <br />City State Zip Coae City State Zlp Coae <br />Stand Island, NE 68801 brand Island, NE 68801 <br />Phis Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraska- Notice is hereby given that taxes including penalties and interest, which aze <br />shown below. aze due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a lien in the county for real and personal property belonging to the Taxpayer t,r hcrcaficr acyii mod. <br />Tax <br />Category <br />Nirm6er Date of i <br />lax Peripd Amount of Tax <br />Assessment j <br />~- <br />- ~ ~ <br />Penalty interest I Additiorn <br />~ faience of <br /> <br />Assessment Due <br />21 07-O1-82 thru <br />~ <br />i09-30-82 ' - 1- 207.35 10.37 E.44 ~ I 22x.16 <br /> I ~ <br /> i <br /> tr <br /> I <br /> I <br /> s ~ ~ ~ <br /> TOTAL 5 224 16 <br />i ttembY certi [ttat tree Nebraska Oeparfinent cr Revenue nas com plia0 witty the re enue taws o4 the State of Nebraska in tree deter- <br />minatlnn Of t Ounl mown to a nub. O Re taxpayer nas fdliea t0 pay the amount Ope after tleman0. l} this NOtfte of State Tax <br />Lien IS an E SIOn 01 do EffectlvB~llely.li-~¢t~gY'Lu COn[fnue-}ft(i Dr1U+ity o! the st ale's intefes[ in thB affectetl OfopeftY Oi the taxpayer. <br />510 ~e'~~~=/'~." ~-~'~`~1 Revenue Agent 1-20-83 <br />he~a 's Sig Title Data <br />.~ ~-~~a~~"'"- Special Aaent 1-20-83 <br />Autnnriietl Slgn r6 title Date <br />~ FOR COUNTY OFFICIAL'S USE <br />NE$RASKR DEPARTMENT OF REVENUE -whits snd Goltknrod Copies <br />TAXPAYER -Pink Copy COUNTY OFFICE -Canary Copy <br />a-49474 Rev. 7-al <br />Supersedes 4-446-74 Rev. 5-80 <br /> <br /> <br /> <br />