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~~nebraska <br />department <br />f ..,,.....e <br />Notice of State Tax Lien <br />•Read instructions on reeerw side <br />Lien Serial Number Lien Type Dale Social Security Number - <br /> ® Orf91nd1 <br />4/03/722 ~ Renewal 2_29-83 507-38-7028 <br />Nebraska I.D. No. County Lien Flletl Wlth $pOUSe's Social Security ti U 1131 <br /> ® Register of Oeatls Number ~4 ~~ <br />3349438 Hal 1 ;7J. cp,.nty uerk <br />BUSINESS NAME AND LOCATION AUUXESD- <br />auslness Name Name <br />Golden Horseshoe Carol J. Price <br />Street Atltlress Street or other Melling Atltlress - <br />2 S uth Iii h Street 402 South Hi h Street <br />City State Zip Cotle City State ZIp:COde <br />Cairo NE 68824 Cairo, NE 68824 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes purstwntao.the <br />revenue laws of the state of Nebraska. Notice is hemby given that taxes including perla[fies and-interest; which:arc-: <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These tortes corotitute <br />a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Category <br />Number <br />Tax Period <br />ADssosunent <br />Amount of Taz <br />Penalty <br />Interest <br />Additions <br />A Ow- <br /> <br />O1 11-O1-83 thru <br />11-30-83 <br />2-29-84 <br />241.88 <br />7.48 <br />6.40 <br />255;J6 <br /> <br />O1 12-01-83 tfiru <br />12-31-83 <br />2-24-84 <br />251.47 <br />7.79 <br />3.38 <br />263.J4 <br /> <br />O1 01-01-84 thru <br />01-31-84 <br />2-29-84 <br />232.02 <br />7.18 <br />.36 <br />239:56 <br /> i l <br /> I <br /> i <br /> <br />TOTAL ~ S 758.46 <br />1 hereby certify tnai the Nebraska Department of Revenue has complied with the revenue laws of the 5[nte of Nebraska In.the.d6ter.- <br />minatlon of the amount shown [o be due, antl the taxpayer has falletl to paY the amount due after demand. It this Notiu Of State~Tax <br />Lfen Is an extension of an effectty¢ Iten i[ serves to continue Inc priority of the 5tate't Interest in the affected property of tM taxpayer: <br />sign /' J/ Revenue Agent 3-1-84 <br />here -~ ep1roY55 re <~,Z~ n ~ Tltl¢ Dat¢ _ . <br />~ /~f ~/1irlJ J Special Agent 3=1-84 <br />Authorizso 51 tr~e~ ~ Title - Date <br />FOR COUNTV OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE -White and Goldenrod Copies TAXPAYER -Pink Copy <br />COUNTY OFFICE -Canary Copy <br />4-494-74 Rev. 7-el <br />Su Dersetles 4-494-74 Rev. 5-80 <br />L <br /> <br /> <br /> <br />