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~ttebraska <br />deparirrrent <br />i.,f.e„ <br />Notice of State-Tax Lien <br />• Rsad instructions on revere side <br />Llan $arlal Number Lien Type Dat@ slit Fal Security Number <br /> Original <br />3 02 039 L Renewal 2-3-83 505-72-3936 1 Y ~i(~ ~y <br />NtbrdSka I.D. No. County Lfen FIIeO With sppuseY soelal Saeutity ` <br />X 3-a `~ ll tl7 ~ ~.7 %~e <br /> ~f Re9ist¢r of Deeaz NUmtrer VVV <br />2487217 Hall g] cDpnty aerk <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAllINO ADDRESS <br />Busine55 Nem@ Name <br />Snack Sho Rodne Lenz. <br />Street Atldress street or Other Mailing Aatlress <br />102 West 4th 707 St Paul Road A t. ~5 <br />city State Zlp Coa@ city sUte ZIP Coae <br />Grand Island NE 68801 Grand Island, NE 68801 <br />This Notice of State Tax Lien is issued by the Nebraska DeparTtnent 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 [he 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 or hereafter acquired. <br />Tax <br />Category Tax Period <br />Number Date of <br />Assessment <br />; Amount of Tax Penalty Interest <br />Additions Balance of <br />Asseament Due <br />04-O1-87 thru ; <br />0106-30~-81 2-2-82 136.54 i -0- 28.91 165.45 <br />X07-01-81 thru <br />~ ! ' <br />Ol '09-30-81 2-2-82 107.18 5 i00 ~ 18 91 131.09 <br />10-01-81 thru <br />O1 112-31-81 1-30-82 116.98 5.00 ~ 16.51 ' 1 <br />;01-01-82 thru <br />( <br />0~ i03-31-82 ! 12-13-8 5.00 <br />10.17 <br />91.75 <br />_ <br />_ 106.92 <br />?04-01-82 <br />! _ <br />__ <br />__ <br />_ <br />- _ <br />Ol 06-30-82 12-13-8 22.14 ' -0- 1.59 23 73 <br />07-01-82 thru ' <br />~ <br />~ <br />-- <br />-- 101 5 5.00 3.71 110.56 <br />j ~ <br />TOTAL I ~ 676.24 <br />1 hereby [@Ittfy Ihdt the Nebrd Ska D@partm ant Ot Revenue nay CO~n plietl with She ray@nu@ Id WS Oi ih@ stat@ Of NBDrdSkd fn the tleter- <br />minatlOn Of OUDL ShOWU [O be tlue. dntl th9 taxpayer nay (daetl to pay the amount tlue af[@f tlemdntl. It this NOfICe Of $L@L@ Tax <br />Lien 15 do fl5ipn Ut an efts a Tien ve5 t0 continue the prrOrrty Ot the stafe'S Iniere5f in thB dtfeciea property Of In@ taxpJayer~ <br />S~gD r _ Revenue Agent ~ ~/~ <br />`~~ tar's Ss9n ~ 7 title Date <br />" Special Aoent <~-4~-83 <br />Authorizes stgnat d. Title Date <br />I FOR COUNTY OFFICIAL'S USE <br />NEBAASKA DEPARTMENT OF REV ENUE - wnrte and Gotdenrod Cbpras 'TAXPAYER - Pmk Copy <br /> <br />COUNTY OFFICE -Canary Copy <br />4.49474 Rev. 7-a] <br />~uper5@tlei A-494.74 Rev, 5-aD <br /> <br /> <br />