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<br />~ebraTka <br />detTartment <br />bf revenue <br />r <br />Notice of State Tax Lien <br />• Read instructions on reverse side <br />Lien Sariai Number L46n"Type Date Social Security Number <br /> <br />Ori9inai <br />t"J <br />(~[~~ Qyn~ <br />o <br />, <br />~~'-' <br />3jfl2/112 Q Renews, 2-23-83 472-48-5479 ~J <br />V <br />V ll <br />NebraTka 1.0. Nd, CounTy Llen Flted With Spouse's Social Security <br /> [~ Re9lster of Deed Number <br />4254#22 Hai i [$ county clerk <br />BUSINESS NAME AND W(:A7 WN AVUtstal I <br />Business Name Name <br />Courtes ourt M Dewa ne R. Mickle <br />Street Address Street or Other Malting Adtlres5 <br />3 e d 36 tdest 104th Stre t <br />Ci;y State Zip Code City State Zip Code <br />r d I Bloomington MN <br />This Notice of State Tax Lien is issued by the Nebraska ikpartment of Revenue for unpaid taxes purstaant to the <br />revenue laws of the state of Nebraska- Notice is hereby given that taxes including penalties and interest, ufiich are <br />shown below, are dt~ from the taxpayer specified above and remain unpaid after demand. Theme taxes constitute <br />a Gen in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Catapory <br />Tsz Period Date of <br />Assessment <br />Amount of Tax PenaitV ~ Interest <br />Additiore Balande of <br />Assmsment Due <br />NttmMr <br /> 06-O1-$2 thru ~ ~ <br />68 06-30-82 11-28-82 100 89 5 00 i 9 <br /> 07-07-82 thru <br />68 07-31-82 1i-28-82 107,32 ~ 5 00 7 0 <br /> 08-01-82 thru ' i <br />68 08-31-82 11-28-82 112 94 ~ 5 00 ~ 5 28 <br /> 09-01-82 thru i <br />68 09-30-82 11-28-82 152 95 5 0 6 9 <br /> 10-Oi-82 thru <br />68 10-31-82 12-6-82 93.46 5,00 ` 3 06 1 ~ <br /> 11-01-82 thru <br />68 11-30-82 12-31-8 8 i <br /> <br />TOTAL ~ S 70q 28 <br />i hereby Certify that the Nebraska Department of Revenue has complied vr~th [ha revenue laws of the State of Nebraska in the deter- <br />mination of th mount mown t44 ~be tiue, antl the taxpayer h3z tailed to pay Inc amount tlus after demand. If this Notice of State Tax <br />Lien i5 an E stun d/ an eftet[fye ilen ~arveT to ontinue the Vr4ority of the state's interest 1n the a}feGted property Of the taxpiYer. <br />sign .~ r Revenue Agent 2-23-83 <br />`~~ rY Signatu 1 - ~ Title Date <br />u ' ~r -- _ Special Agent 2-23-83 <br />Authorised Si9nat Title Date <br />FOfl COUNTY OFFiCiAt.'S USE <br />NEBRASKA DEPARTMENT OF REVENUE -White and Gdddtrod Copies TAXPAYER - Pmk Copy COUNTY OFRCE -Canary Copy <br />a-a9a•ra Rev. 7-at <br />Supe~Sades a-494-7a Rsv, 5-90 <br /> <br /> <br />