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nebreska <br />artmenf <br />t('' tii reVen4e <br />t <br />Busin¢55 Name <br />fyt7 ~-~.7Y(3- r <br />Street Adtlre65 <br />142as a <br />City <br />ANU lVl.rs t rsirv nvurscw .. .--.. -. -.- -_. - <br />Nama <br />Street or Other Mailing Atltlress <br />State 2tp Cotle iCity ara.a <br />This Notice of State Tax Lien is issued by the Nebraska Departrnent 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 fm real and persona} property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Cat@gpry <br />Number <br />Taz Period Date of <br />Assessrnent <br />Amount of Tax Penalty <br />i <br />Interest <br />Additiom Balann pf <br />Assessment Due - <br /> 9/1/$2 tt,r„ <br />1 71-/sa t~ <br /> i ~ <br /> <br /> ~ i <br /> ~ ~ <br /> <br />TOTAL I $ ~p~d 7d <br />I Hereby certify that the Nebraska Department pf Revenue Has compiFetl with the revenue laws of the State of Nebraska in the de[er- <br />nalipn p( the amOUnk shown [G b¢ due, and [he taxpayer has fdlled t0 pay the dmOUni dUe aftef demantl. If this NOtICe O{ State T¢X <br />Lien is an enSlOn of an a+teGtive tien it ss,l~er~r~ves fo carttinue the priority o+ the State's interest in the difectetl property of the taxpayef- <br />Stgfl ~-_~rz~~~~jj/ _ ~~ fdP[TCTf1P AQP7S{' ?/~ /R~ <br />`~~~~eparet'S netWe 7itfe Date <br />!' Mana{~pr 7/1 /R~ <br />Authorlxed Signature Title D Le <br />f FOR COUNTY OFFICtA1'S USE <br />- PlEBRASKA OEPARTMENTOF REV ENUE -White end Goldenrod Copies TAXPAYER -Pink Copy COUNTY OFFICE - Censry Copy <br />'- - @-@96.7a Rev, 7-81 <br />- Supersedes 4-694-)4 Rav- 5-ae <br />Notice of State Tax Lien <br />•Read instructions an reverse fid+ <br />L(en Serial Numbe+ Lien Type Date Soclai $ecurlty Number (~~` U G O <br />Jr <br /> <br />~ orl9inat <br />2/]-/$3 t <br />V <br /> Renewal <br />Natiraska I.D- No. County Lien /•hetl wifh 56ouse's-Soclat Security <br /> Ra9i5ter at OaadS Numner <br />3773922 Hall. cpp~ty c{erk <br />-i <br />