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I <br />Notice of State Tax Lien <br />atebtaska <br />tment <br />f revanut • Riid irtatruetiem nn r~irw itde <br /> <br />Liin Srrlal NLmbar Llen Type Oate Spcisl 5eNrity NumbH <br /> <br />4/O2t6O2 Ort9inal <br />^ Ranewat <br />-1-s4 <br />~~ -- Ut~0552 <br />Nebraska I.D. No. Copnty Lien Flted with Spouse's Social Saturtty <br /> Register of Oaatls Number _ <br />4533634 Ha 11 ~ cpunty stark <br />wwmcarw ngrwc qnu s.wq rrun quuneaT TAAPAYER NAME AND MAILING ADDItEaft <br />Bus/nays-Nafne Nami <br />Good Health Med. Wt. Loss Ctr, a. I, Inc. Cood Health Med Wt Lo Ctr <br />Streit F.tlbress StrN[ Or Other Miatn9 Address <br />2500 North ldehh Road 1800 6 berr Rd 8uildin 8 <br />City State Zip eotle CItY State Zlp'COtlt:- <br />Grand. Island NE 68801___1 Huntinoton +/allev, PA 19pQ5 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pulwaltt to-the: <br />revenue laws of the srate of Nebraska. Notice is hereby given that taxes including penalties and intaeat; whieb-are <br />shown below, are due frem the taxpayer specified above and remain unpaid after demand. These, taxes rnoatiiute <br />a Gen in the county for real and personal property belonging to the taxpayer a hereafter acquired. <br />TiY <br />NumWry <br />TaY Piripd <br />Dab of <br />Asiramint <br />Amount of Tax ~ Penany <br />Intanst <br />Addition <br />A 9aaelatnetrt Dw <br /> <br />21 67-O1-83 thru <br />X09-30-83 <br />0-31-83 <br />411.39 ! 2n.57 <br />14.67 <br />446.63 <br /> <br />--~ - <br /> i <br />L <br /> -- ~-------- <br />-- ----t- ------} <br />I <br />-- <br /> i i <br />i i <br /> <br /> TOTAL ~ s 4n6 63 <br /> t neYapy cart7/y that the Nebraska Qepar[m ent of Rave»ue has c mpitetl w{th the rerinua taws oT the State OT Nebraska in the tlaterv <br /> minatlon pT the amount shown io »a pue, ana tna taxpbyar nas tailW to pay the amount tlui after tlamand. !T th is Notice oT State TaY <br /> L{e» is an extension of an effective flan ft 58rv es to continue the priority of th! sta[a't Interest in The affectatl pro perty oT the taxpiyir. <br />E~ J - ii ~~gg <br />,A f~6t.~ Revenue Agent 2-1-84 <br /> <br />~~~ P prawnr`s ! Tltia <br /> <br />~ Date <br /> <br />~ ~ - ~ Special Agent 2-1-84 <br /> ARMOrized si un ~ Ti Ue oaea <br />FqR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REV ENUE - White antl Goldenrod Copies TAXPAYER -Pink Copy <br />L <br />COUNTY OFFICE -- Canary Copy <br />4-a9a~a Ray. T-e 1 <br />Supersatles 4<94-~4 Rev- 5-BOI ' <br />s~ <br /> <br /> <br />