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fte6raska <br />department <br />Notice of State Tax Lien <br />• Read instructions on reverse side <br />Lien rial-NU ber Lien Type Date Social 5@writyNumber <br /> i original <br />~ <br /> <br />(i ]~ 3 , <br />,~ Renewal 2-28-83 505-64-$102 <br />Nebraska I.D. No. County LI@n FI(ed With Spouse's Social 5@cuNty `l ~~ ~ r^. <br />j <br />• <br /> ~, Register of OeetlS Number ~~ <br />- <br />`V <br />a <br />~I-3976602 Hall ®eounty clerk <br />~- BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name rvame <br />ililber Auto Care & Re air Daniel G. Shaul <br />Street Adtlress Street or Other Mailing Atldres5 <br />202 South Wilson RFD, Box 100 <br />City State Zip Coae city State Zip Catle <br />ailber NE 68465 _ Donninhan, NE 68832 <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 />a lien 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 of Tax i Penalty ~~ Interest <br />~ <br />Additions Balance pf <br />Assessment Due <br /> <br />O1 01-01-82 thru <br />O1-31-82 <br />02/27/82 <br />$61.33 $5.00 j $8.59 <br />$ 74.92 <br /> <br />O1 02-01-82 thru <br />02-28-82 <br />05/19/82 ~ <br />28.21 3.61 <br />31.82 <br /> <br /> t- <br /> - <br />- <br /> ~ <br />I <br />I <br />j <br /> i ~ ~ <br />TOTAL ' S 106.74 <br />I he(eby te(tify that the Nebraska Department of Revenue has Cam Vlietl v.iln the revenue Ia WS of the State Of Nebraska in the tleter• <br />minatiOn Of Lh@ dmOUn[ shOWn to p@ tlue, 3na the taxpdyer has fdif¢a t0 pdy [h@ amount due after aemdnd. If this NOtiGe Of State Td% <br />Lien Is an a%t@n51an of an effgt[IVe lied i[ S@rves to ton[ln Ue the priofitY pt the 5tat2~5 rnteresl in the dff@Cied prOperfy Of the tdxpdyef. <br />sign ~ , l Revenue Agent ~, - ~ $ - <br />h8~e arer'z Si natur@ r T~:le Date <br />(i Manager ~~~~_ ~~A~~ <br />uth Iaeo Signature Title Date i <br />.- - FOR COUNTY OFFICIAL'S USE <br />N~BRASXA DEPARTMENT OF REVENUE -White and Goldenrod Copies TAXPAYER - Ponk Copy <br />COUNTY OFFICE ~- Canary Copy <br />449474 Rev, 783 <br />Supersetles 4-094-74 Rev. 5-60 <br />u <br /> <br /> <br /> <br />l_._ <br />