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<br />r <br /> <br />11m.. ...ne... bra.'ka <br />~artment <br />,of revenue <br />Lfan serial Number <br /> <br />Notice of State Tax Lien <br /> <br />rc <br /> <br />3/04/329 <br /> <br />Lien Type <br />o Original <br />o Renewal <br />County <br /> <br />Date <br /> <br />. Read instructions on reverse side <br />Social Security Number <br /> <br />40507058 Hall <br />BUS'INESS NAME AND LOCATION ADDRESS <br /> <br />Lien Flied With Spouse's Social Security <br />{] Register 01 Deeds Number <br />.'[] County Clerk <br /> <br />83-001887 <br /> <br /> <br />Nebraska 1.0. No. <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />B'usloess Name <br /> <br />Name <br /> <br />State <br /> <br /> <br />Zip Code <br /> <br /> <br />1009 W. N. Front <br />City <br />Grand Island <br /> <br />Zip Code <br /> <br />NE <br /> <br />68801 <br /> <br />Grand I 1 nd <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of Re\'enue for unpaid taxes pursuant to the <br />re\'enue law. of the state of Nebraska. Notice is hereby gi\'en that taxes including penalties and interest, which are <br />shown below, are due from the taxpayer specified abo\'e and remain unpaid after demand, These taxes constitute <br />a lien in the county for real and persnnal property belonging to the taxpayer or hereafter acquired, <br /> <br />I Tax Date of Balance of I <br />Category Tax Period Assessment Amount of Tax Penalty Interest Additions Assessment Due <br />Number <br /> 1 2 -01-82 thru I <br /> I <br />01 12-31-82 2-3-83 247.83 i -0- 7.03 254.86 <br /> 11-01-82 thru I I <br />01 11-30-82 3-8-83 187.47 5.80 7.55 200 82 <br /> 01-01-83 thru <br />01 01-31-83 2-28-83 140.89 5.00 ! 2.49 148.38 <br /> 02-01-83 thru I I <br />01 02-28-83 4-15-83 199.94 6.18 1.15 207 27 <br /> I <br /> . <br /> . <br /> TOTAL $ 811.33 <br /> <br />I herebY,cerUfy- that the, Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the deter. <br />minaUon of the arnounLshown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax <br />Lien is:ag nsiQJI of all e tive tie ~'t serveS to continue the priority of the state's interest In the affe<::ted property of the taxpayer. <br />;/ <br /> <br /> <br />Revenue AQent <br /> <br />4-15-83 <br />Date <br /> <br />Title <br /> <br />Special Agent <br />Title <br /> <br />4-15-83 <br />Date <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />I'!EBRASKA DePARTMENT OF REVENUE - White and Goldenrod Copi., <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Canary Copy <br /> <br />4.494-74 Rev. 7-81 <br />Supersedes 4-494.74 Rev. 5.80 <br /> <br />L <br /> <br />--.J <br /> <br />L <br />