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<br />I <br /> <br />I~eb,a'k' <br />~artment <br />of revenue <br />Lien Serial Number <br /> <br />Notice of State Tax Lien <br /> <br />Date <br /> <br />. Read instructions on reverse side <br />Social Security Number <br /> <br />Nebraska I.D. No. <br /> <br />Lien Type <br />e9 Original <br />o Renewal <br />County <br /> <br />4-8-83 <br /> <br />3/04/326 <br /> <br />2962713 <br /> <br />Lien FHed Witt; Spouse's Social Security <br />~ Register of Deeds Number <br />Ha 11 0 County Cle" <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />83-001721 <br /> <br />BUsiness Name <br /> <br />Name <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Yancey Motor Hotel Grand I~land Tnc <br />Street Address <br /> <br /> <br /> <br />City <br /> <br />Grand Island, <br /> <br />NE <br /> <br />6880 <br /> <br />Zip Code <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Deparnnent 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 hereafte, acquired, <br /> <br /> <br />Tax <br />Category <br />Number <br /> <br />Date of <br />Assessment <br /> <br />Tax Period <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />21 <br /> <br />58 ?O <br /> <br />, . <br />i I <br />. -~lLr -~~I <br />i <br />I <br /> <br />I <br />I <br />I <br />+- <br />I <br /> <br />siln <br />h <br /> <br /> <br />I nereby certify that the Nebraska Department of Revenue has compIled witn the revenue law;. of the State at NebraSka in the deter- <br />mination of t amount snO::ri1 to be due, dnd the ta payer has f<uied to pay the amount due after demand. If this Notice of State Tax <br />Lion is an , sion of an eff]CliVe lie ' serves t c nHoue the prionty of the state's interest in the affected property of the ta.xpayer. <br /> <br />Additions <br /> <br />Balanca of <br />Assessment Due <br /> <br />II <br /> <br />TOTAL <br /> <br />I <br />~,~ <br /> <br />2,231 14 <br /> <br />fill 70 <br /> <br />Revenue Aaent 4-8-83 <br /> <br />,.,', Sl~y / '7 ~:7R . T't1~peci a 1 Aaent D.t~_8_83 <br />. Aut""".a" ~i.;;;~L~<;\.-.:;:i~....-; Tit'. ~ <br />FOR COU'll.!.~..<:J.F!~IAL'S U~E__________~._______________=:::J <br /> <br />NEBRASKA OEPARTMENT OF REVENUE - White and Goldenrod Copies <br /> <br />T AXPA YER -- Pink Copy <br /> <br />L <br /> <br />L <br /> <br />COUNTY OFFICE .- Canary Copy <br /> <br />4-494-14 Rev. 7.81 <br />Supersedes 4-494.14 Rell. 5.80 <br /> <br />....... <br /> <br />~ <br />