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Notice of State Ta~c Lien <br />nrbraska <br />tfepartment - <br />)(''' of revenue •Read Innrueriorta on reverse side <br />1 <br />Um Sariaf Number lien Type Date 5oclal Security Number <br /> j Original <br />8 03 060 ~A@newai 3-31-78 506-58-9926 ~,~..--.(,{i0~j5[} <br />Nebraska l.D. NO. County l <br />i <br />nFiiea With <br />a Spouse's $oclai Security <br /> p <br />- <br />~ <br />Register of p@eOS Number <br />2766590 Hall ~ <br />'U COUnFy Cierk <br />BDSINESS NAME AND tOCAT10N ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />_~larold Putcher Harold Putcher <br />5tre9t Address Street or Other Malting Atldre55 <br />P.O. Box 175 ~ P.O. Box 175 <br />City State Ztp Cade City State ZIp Cotle <br />_Wpgd River, NE 68883- ttaod River, NE 68883 <br />This 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 are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />alien in the county fa~ real and personal property belonging to the taxpayer or hereafter acquired. <br />lax <br />Category <br />t Number' 1 <br />I lax Period I Date of <br />Assessment , Amount of Tax i <br />I ~ <br />Penalty <br />~ Interest <br />Additions <br />Balance of <br />Assessment Due <br /> ;10-O1-76 thru <br />27 112-31-76 (1-31-77 ! 1 97 1.66 3.63 <br /> '1-01-77 thru ~ I <br />21 i3-37-77 ~-30-77 I 26 19 ; 1 31 t 1 44 28.94 <br /> j4-O1-77 thru i ! <br />21 F6-30-77 ~-31-77 ~ 35 56 1 83 46 ~ ~ 39.85 <br /> i <br /> <br /> <br />I <br />~ j <br />i ; <br />I <br /> <br /> <br /> <br />-T- --F <br />~ ~ <br /> <br /> <br />- <br /> <br />- <br /> <br />, <br /> <br />I <br />±-- ~ <br /> <br />i <br />-j <br />I <br />--~ <br />~ <br /> <br /> <br />- <br /> <br />-- <br /> - - - ----- _ - TOTAL 1 5 72.42 <br /> <br /> <br /> <br />lgll -'mchep ~w .;n the r@ e @ laws of the State pt Nepraska in the deter- <br />mindtfOn of the ampUnt Shpwrl to a@ nue, anp the idxpa yer n 5 tailep t~ paY the a unt pp after tlemantl. It ihi5 Notice pf State Tax <br />Lien is an exS@nsion of bn rrlfec live li¢n t tp continue the prrpr~ty of the state's Enteres[ In Fha aifectetl prop@tty pt the taxpayer. <br />~e t`=~-c- Special Agent 2-9-83 <br />~~~ Pgparor's 5i9n TiU6 Date <br /> . s-, e <br />~'Z~ ~ Y-~ -- Special Agent 2-9-83 <br />~ ) <br />Autnorl2ed 519natur/- T~tie n,,. <br />NEBRASKA DEPARTMENT OF REV ENUE - Wltite and Goideruod Copte; TAXPAYER - Pmk Copy <br /> <br />COUNTY OFFICE -Canary Capy <br />4-494-J4 Rev. ]-8] <br />Sunerys0@s 4.494-14 Rav, 5-a0 <br />......1 <br /> <br />