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I <br />Notice of State Tax Lien <br />_.°4sebraska <br />artment • Read instructions on rawrsa side <br />Liars 5arlaf Number pert Type Oate 5 lei Security Number ! <br />pc <br /> Ori91na1 _ <br /> <br />4/42/6fl5 <br />~; Renewal <br />2 n3-84 <br />545-54-938b . <br />}}~s <br />N COUnfy Lt f{i¢d Wktn Spquse's SOCIaf aacurity 7(~ r~ ~) ~ O ~ 2 U <br />'''"'ffffff <br />q. <br />Nabrafke l.D. I Register of Deed Number VV <br />275138fl <br />--. Hall ®County Clerk <br />ss IasR.AiffeAF56-~ <br />BUSINESS NAME AND LDCATiON AVUntaa - - - --- - <br />Name <br />Business Nam¢ <br />Safari Bar ~ lounge Verlie G. Johnson <br />Street AdOress Streei Or Otner Maiiln9 Adtlfass <br />146 East 2nd StrPQ* 843 Shad Bend Road <br />r_;ty 5taze zro cpae city state zip cgde <br />trend Island N£ 68841 Grand Island ,'lE 68841 <br />This Notice of State Tax Lien is issued by the Nebraska lleparhnent 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 faces constitute <br />a lien in the county frx real and personal property belonging to the taxpayer or hereafter acquired. <br />Tix <br />Cassaory <br />Number <br />Tax Period bats of Intsret <br />Assessment Amount of Tax ~ PanaHy I I <br />r Additions italmw of <br />Asssonsassr-Ous <br /> <br />Ol 49-41-83 ihru lI <br />49-34-$3 1 ? ! <br />2-3-84 ~ 163.12 5. _4 ! 6.51 179.83 <br /> <br />41 14-41-83 thru <br />]0-31-83 1 ' ~ <br />2-3-84 ~ 131.59 5.44 3.53 i <br />140.12 <br />j <br />O1 l1-41-83 thru <br />1i-34-83 I i <br />2-3-84 129.43 5.44 2.29 <br />156.32 <br /> <br />41 ! 12-01-83 ihru <br />12-31-$3 <br />!2-3-84 I 151 _c2 __'7_4~-'.:?2 <br />~_ <br />157.34 <br /> ! i I <br />I ! <br /> ! <br />~ <br /> --- <br />- <br />TOTAL ~ S 633,61 <br />1 hBYeby certify that th¢ Nenraska Oaparltl the taxpayer has Paned toll pdY the anmOUnt tluel alto! tlameand t If this Notice Of $[ateaTdx <br />naGOn of tn¢ amount sngwn to De qve, an <br />Lien is an extenftgn Of an effective 11¢n It f¢rvef to cgntinu¢ the prlorlty Oi the state's Intefesi in the atfettb property of th¢ [axWYer. <br />5111 ~ 4r~Ylff.4'Yb~tffn ©~~, Revenue R€}ent 2.-3-84 <br />eparar'3 519 r _s_ T{tla -- Date <br />h~ ---~~ecial Agent 2-3-84 <br />Autngrized Si9natlt rifle Data <br />t- F COUNTY OFFICIAL'S USE - <br />;NEBRASKA DEPARTMENT OF REV ENUE - Whete andGotdenrod Cppies TAxPAYER -Pink Capy <br />L <br />COUNTY OFFICE -Canary Capy <br />4-49x74 Rev. 7-a1 <br />S upersetles 4-494.74 Rev. S-a6 <br />u <br /> <br /> <br />