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i _ _., u t INSTRUGT[bN5 PURPO&E OF FORM: This form is to be used- by the Nebraska E ~ Depamnent of Revenue farthe purpase of notifying the appropriate --~ ~ ~ ~~ [ county authorities that a Notice of State Tax Lien is being filed against the taxpayer indicated on this fomt. The-tax category number codes and- the Nebraska tax programs they represent are listed below. 41 .............................Sates Tax ,. E, s Q2 ........................Retailers Use Tax 04 ...................... Consumers Use Tax 10 ............................Pori-mutuel ': 21 ...................income Tax Withholding 22 ....................Individual Income Tax ' 23 .....................Fiduciary Income Tax 24 ...........Corporate Income and Franchise Tax 36 ...................Documentary Stamp Tax 44 ............ Mechanical Amusement Device Tax 45 ..........................Severance Tax 46 ............................ Estate Tax 47 ...........................Cigarette Tax 69 .............................Litter Fee 68 ...........................Lodging Tax 71 .............Interstate Motor Carriers Fuel Tax 81 ...........Motor Vehicle Fuels Importing Dealer 85 ..........................Aircraft Fuels 91 ...........................Special Fuels ~ n N rn w e~ --a ~ C aA ~iQ ~ -n z -+ W f n, ~ ~~ sz a, rrrt "~ m ry a~tl ~ y; ~ T o -. ~ t7 ~ tL \ ~ ~ m v (~ ~ ;- r.~ ~ ~ ~ r r ~ cn ~ 3 tA~A ~ ~.n ~.4` p p; ~a 1' ~ ~~ ~ ~} ,- ~, ~~ ~..,,a ~,-.- ~ ~..,..