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II. S~ebraska department of revenue Notice of State Tax Lien . Read instructions on reverse $ida Lien SeriC!l1 Number Lien Type Date Social Security Number 3/04/328 ~ original 83-O0185~ o Renewal 4-15-83 507-56-1063 Nebraska 1.0. No. County Lien Filed With Spouse's Social Security []. Register ot Deeds Number 3531503 Hall o County Clerk i BUSINESS NAME AND LOCA nON ADDRESS TAXPAYER NAME AND MAILING ADDRESS I Business Name Name Thomsen Construction Co. Lavern E. Thomsen Street Address Street or Other Mailing Address 208 South Oak 208 South Oak City State Zip Code City State Zip Code Grand Island NE 68801 Grand Island NE 68801 This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid !aJ<es pursuant to the revenue laws of the state of Nebraska, Notice is hereby given that taxes including penalties and interest, which are shown below, are dne from the taxpayer specified above and remain unpaid after demand, These !aJ<es constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired, Tax Category Number Tax Period Date of Assessment Amount of Tax Penalty Inter~t Additions Balance of Assessment Due TOTAL s 48 7 I hereby certify that the Nebraska Department Of Revenue r,as c.ornplieo with the revenue laws of the State of Nebraska in the deter- mination of th amount sh wn to be Que, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an ension of an ef clive lien. Jerves to co"tinue the priority of the state's interest in the affected property of toe taxpayer. -- J Revenue Aoent 4-15-83 Tltie Date Special AQent 4-15-83 Date Title FOR COUNTY OFFICIAL'S USE .~:f NEBRASKA DEPARTMENT OF REVENUE - While and Goldenrod Copies T AXPA YER - Pink Copy COUNTY OFFICE - Canary Copy 4-494-74 Rev. 7.81 Supersedes 4-494.74 Rev. 5-80 L .-J L