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raska <br />tmeitt <br />of revanva.- <br /> <br />Notice of Ste#e Tax-Lien <br />~Rwad inatruations PR rererw side <br /> <br />.e Sertaf.NUmpar <br />~' ~ <br />' Llert TYDB <br />Date <br />SOLiat58eurity Numtlar - _ __ <br />- - - <br /> ~ Drigmat, - <br />4 ~1 464 C Rsnewal 1-20-84 505-54-3$79, f <br />/~"}} ~n} <br />Q ( <br />~ <br />Nebraska I.D_ (Y4. County Llen FSietl. Wiih Spouse's SoLfal SeaurltY tt <br />~ <br />~ <br />M~ w„e <br />4J tJ V !~ ~} tJ. <br /> QC] Ragtster of Dserts Number _ <br />i <br />iiiiii <br />~t <br />.. 27800&2 ryry <br />f]d. 5-~ - ~ County Gefk-. - <br />- - - BUSINESS NAiME-ANO-tOCAT10N-AUDRE~..~' - - ..!.wTnr= ^^~° ^,• ^ `•••" <br />8tis,nass Nanie - -Name -Manta Clark Poratn d/b/a- <br />Mit:hael*s F]oral $-Gift. _ ~ Michas}`s,Fl oral o, Gaft __ <br />- - StYeet-Adores.. - - - - Stlaet Ot Wither Malting AddfoSi-' <br />1T5 West 3rd` 115 West 3rd <br />' Ci;y - - State ZiP Code - City: SSSte - ZIP Cod <br />brand Is}and, NE 68801 Grand Is]and hiE 68801 <br />This'NoUce of State Tax Lien is issued by the Neuraska I3epar;tttent of Revgnue for uetpai3taz~.pursu~t to rite <br />rereitue laws'nf-the state of Nebraska. Notice- is hereby given that taxes including penalties and`interest; which aze <br />shown belt»v, are dire fmm Ute taxpayer specified shove-and-remain unpaid:af#et demand: Theae;ta~ces constitute <br />a lien in the county {or real and personal property belonging to the taxpayer or hereafter:asquired. <br />T~-- <br />Category. Tax Puitxl ~ AO~s°Mt Amount PI Tex j .Penalty <br />Numtrx <br />Ihterast - <br />- Additions--. Balance of <br />gsspsunent Ouc <br />]0-Ol-S3 tbwu <br />0]- •10-31-83 12-23-83 i36_R5 ! 5.32 <br />2:94- <br />1.45.22 <br />~ ~ i <br />! I I <br />I i 1 1 <br />r------ <br />I i ~~- <br />I <br />i ~ <br />~ ~~ ~ <br />TQTAL 5 145.22 <br />- - - 1 neReGy <IIriity that tht Nebraska-DePariment Of Revenue nay Lomplietl wHn Ma revenue ldwc of the State Of Nebraska-in the'tleter- <br />- - - mina[ion Ot the amaunS mown [o. De dub, and the taxpayaY hai -iailetl f0 DdY the amount Oue after OemanO. if this Notice Of State Tax <br />- i3en-is in tensi8n-Of an affeGli Ylart i4 se[v8s i9 Continu8 the DrioritY Pt the state's mtara4t In the affected property of Me taxpeYeY. <br />Sl~fl y~~~~~ Reuenue Agent T-20-84 <br /> <br />~ <br />~ eparer't Siga Title Data <br />~~ Special Agent ]-20-84 <br />- ' - - -~ AutnOrizad Signature rifle <br />~ Date - <br />'-- r FO <br />OUNTY OFFICIAL'S USE - <br />- .. Fi£$RA&ifA pEPART&tENT OF REVENUE - Whtte and Goldenrod Copies TAXPAYER -Pink Copy <br />COUNTY OFFICE -Canary CWY <br />4-4447a Rsv, T$3 <br />Su Dersetlas 4-444•]4 Rev, D-$0 <br />u <br /> <br />