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nebraska <br />department <br />of reyeriue <br />-:.+ <br />Notice of State Tax Lien <br />• Read instructions on reverse side <br />Lien $erlai Nu;rtbar Lien Type Date Social Security Number <br /> <br />Orl97na1 <br />~ I~ <br />8 .(~i UUQ82$ <br />.3.02 .110 n <br />n <br />L: Renewal 2-17-83 508-56-7497 Val <br />Nebraska 1.0. No. County Llen Filed With Spouse's Social Security <br /> Register of Osea Number <br />1892991 }{all ~ County Clerk <br />BUSINESS NAME ANU LU(:A{IVN AUUit tJJ 1w.trrat en wHmc grvsi mfsr r_nvaa rsvvr.ca~ ~ <br />Business Name Name <br />$tre8t AddreSS Street Or Oth¢r Mdlllrtg Atltlr¢ti <br />Ca ital Avenue & Ni hwa 281 2530 St. Patrick <br />Cliy State Zip Code Clty State Zip Code <br />Grand Island, NE 68801 Grand Island NE- 68801 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for uupaid taxes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penaiHes and interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a Hen in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Category <br />Number <br />Tax Period Date of <br />Assessment <br />Amount o{ Tax ~ Penalty <br />Interest <br />Additions Balanee of <br />Assessment Due <br /> 09-O1-82 thru <br />O1 10 -30-82 1-11-83 400 60 ' 13.00 16.75 43 3 <br /> 10-Oi-82 thru ' <br />Ol 1 -31-82 1-11-83 409 41 12.66 12 ?1 <br /> T1-O1-82 thru <br />1 1- -7 -8 0 6 3 95 <br /> 07-O1-82 thru ! <br />I <br /> 3 <br /> 10-01-82 thru <br />21 12-31-82 1-11-83 113.70 5.69 .74 12013 <br /> <br /> <br /> TOTAL $ 1 398 O1 <br /> i hereby Certify That the Nebraska Dep artment of Revenue has complied with the revenue laws of the State of Nebraska in the deter- <br /> mination Of 4pe dmOUnt the f0 be d4E. <br />v ana 2ne tdxpdyef hdt failed tp pay the amount due after demand. It tint NOLiCO pf State Tax <br /> Llan it a (tendon of an ef <br />f <br />~ctlva lie Serve <br />to <br />continue the priority of the state's Interest In the affected prop@rty Of the taxpayer. <br /> / ~ <br />/ <br />~~ ,! /l a"~` <br />Revenue Agent 2-17-83 <br /> rat's ~ ur _ <br />ride Date <br /> a ~~ - ` <br />- ~ <br />Special Agent 2-17-83 <br /> °~AttlholfL 51 ure TiIle Ddt@ <br /> ,c .. FOR COUNTY OFFICIALS USE <br />NEBRASKA pEPARTMENT OF REV ENUE -White and Goldenrod Copies TAXPAYER - Pmk Copy <br /> <br />COUNTY OFFICE -Canary Copy <br />4-a94-1a Rev, 7-$t <br />Supersedes A-49i-7a Rav. 5-$O <br /> <br /> <br />