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<br />I <br /> <br />r <br /> <br />.. .....b,.i1<. <br />department <br />revenue <br />L.tan SerJat Number <br /> <br />Notice of State Tax lien <br /> <br /> <br />Lien Type <br />~ Orlginaf <br />o Renewal <br /> <br />Cate <br /> <br />. Read lnstructiOIl$ on reverse side <br />Social security Number <br /> <br />, 3-21-83 <br /> <br />454-50-7789 <br /> <br />Nebt.as1<<t 1.0. No. County Lien Flied With spouse's Social Security <br />, [R Register of Deeds Number <br />21-3681610 Hall Ql County Cle_' <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />83-U01399 <br /> <br />TAXPA YER NAME AND MAILING ADDRESS <br /> <br />NE <br /> <br /> Name <br /> p 0 Van Ho <br /> Street or Other Mailing Address <br /> p Box 769 <br />Z~p Code City State <br />68843 He burn ID <br /> <br />Zip Code <br /> <br />Business Name <br /> <br />A & N Insulation & Roofin Inc. <br /> <br />Street Address <br /> <br />Rural Route <br />City <br />Ham to n <br /> <br />State <br /> <br />333 <br /> <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 slate of Nebraska, Notice is hereby given that Iaxes including peoalties 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 aud personal property belonging to the taxpayer or hereafter acquired, <br /> <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions <br /> <br />Balance of <br />Assessment Due <br /> <br />16 <br /> <br /> <br />54 74 <br /> <br />-0- <br /> <br />13 <br /> <br />~ <br />I <br />I <br />I <br /> <br />j---- <br />I <br />I <br />i <br /> <br />~ <br /> <br />TOTAL $ <br /> <br />I hefOOY Cetttfy that the Nebraska Department of Reyenue I\aS compli~ with the revenue laws of the State of Nobrask;a in the deter. <br />mlnaUon of the amount shown to btr duo. and the taxpayer has f.3J1ed. to pay the amount due after demand. If this Notice: of State Tax <br />. Uen i' an exV of an ef(:7"Hen~i' ;,"",:';!9 C:~inua Ih. p,io,i'y of tn. :tata's int.,..1 In tha affected "'ope"y of the taxpaye', <br /> <br /> <br />sagn. '<1ft;:-Y- .J.-~~~F" . Speclal Agent 3-21-83 <br />here Preparer's 5ig .. .:: f.... .'..j>."....~ .....'/. Tltht Date <br /> <br />'. .e:.A':!l~'H( ~~(i-~'~^' Special Agent 3-21-83 <br />Authorized Sign.atur _ Title Date <br />FOR COUNTY OFFICIAL'S USE <br /> <br />NEBRASKA DEPARTMENT OF REVENUE - White end Goldenrod Copies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Can.,y Copy <br /> <br />4.494-74 Rev. 7-81 <br />Supelsod$S 4~494-74 Rev. !l-80 <br /> <br />L <br /> <br />L <br /> <br />..J <br /> <br />L <br />