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Notice of Sta#e Tax Lien <br />rtebraska <br />aepxtment _ <br />of revenue -- •Read instructions on reverse aids' <br />Lien Serial Number Lien Type Data - SoGal Security Number <br /> ® Original <br />3 2 04i ^ Renewal 2-4-83 442-38-4806 <br /> <br />Nebraska I.D. No. <br />County <br />Lian Filed Wlth <br />Spouse's Social Severity <br />N <br />be a <br />('y v] r C t [-1 ~ r- i~{ <br />] V lJ ll <br />b <br />949876 Hall ~} Register of Oaetls <br />~j cppniv Clark um <br />r v <br />KUSINtAI NAME: AND Ll1C:I11 IUN.AiIUFItaJ i AJ(YAYtK NAMC ANV mAILINt~ AY4tt C.1b <br />nUSinesi Name Name <br />American Owner 0 erator Lorren W, White <br />Street Atldress Street or Other Mallinq Atltlress <br />Foremerly -Fourth Street Insurance 1206 W 21st Street, Room 303 <br />City State - ZIp`Cotle- City State Zip Cotle <br />Grand Island NE 68801 Ogden, Utah 84401 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenge 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 fakes cons6lute <br />a Gen in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Category lax Period <br />Number Oate of <br />Assessment <br />Amount of Tax Penalty Interest <br />Additions Balance of <br />Assemnen40ue <br />10-O1-80 thru <br />24 -30-81 <br />-10-82 <br />1943.00 485.75 310.03 <br />2,738.78 <br />I j <br />~ I i <br />i <br />i <br />I <br />{ <br />I " i <br />_ ~ ' ~ I <br /> i <br />TOTAL ~ $ 2,738,78 <br />1 hereby Cerilty that the Nebraska Department of Revenue has com pned with the revenue laws of the State of Nebraska In the tleteh <br />mindLlOn of the dmount SnOwli to be Oue. dntl Lhe taxpayer haS ialleb IO pdy Ih6 a unt tlue d}tar tlemand. ff Lhli Noti[e Of $La[e Tax <br />Lien i5 an ez p{jOn of an of fa[tive lien it SarvaS to conilnua the prtotity of the State'S intareat In the atfaGtetl property Ot the taXpdyer. <br />1 /F <br />sign ~ _ special Agent 2-4-83 <br />here Preparer's na • Tiife Date <br />~__ ~p ~,:~ Special Agent 2-4-83 <br />FOR COUNTY OFFICIALS USE <br />NEBRASKA DEPARTMENT OF REV ENUE -White end Goldenrod Copies TAXPAYER - Plnk Copy <br />I <br />COUNTY OFFICE -Canary Copy <br />4.494-74 Rev. 7-91 <br />SupersatleS 4-494.74 Rev- 5.90 <br /> <br /> <br />