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<br />nehraska <br />.Irpa,~i„e~t <br />Notice of State Tax Lien <br />• Rail instrpptipnf on I¢Yelia lids <br />Lien Serial lVUmper r Lq^~ - pa Data <br />.n Sinai I Soriai Security Number <br /> <br />I ~~ <br /> <br />--oo" ~ <br />~ <br />wai <br />e <br />4/(!3/823 F 3-2Q-84 SE15-7w7-5!187 ` <br />_ <br />~ <br />Nabraska f.0. NO. Chu my Sian Filen Vditn p s¢'S Spcial Sac4N1Y - <br /> k ~ RagBtiar ctt Daed Number - <br />3780791 Hell ~ ~y cp+,nty Cfe rk <br />I BUSINESS NAME AND IOCATlON ADDRESS TAXPAVER:HAME AND+iMA$INa~ADDgE&S <br />Business rvama ~~ _-~~~ Nama - - <br />Custom Ferformaace ___ J_ ___ Robert Sufiiuan r_ <br />Straak Adtlrass Sireet n(-btn¢+-MainP4 Addr¢6t <br />~3 6 EV 4ine 3b6 P' trine <br />CstY State Tip Cap¢ City Suta ZIP CoM <br />Grand ;stand __h,E -__- ----- 588111 __..~ , Grand Isl-and 0~ -- . 68801 <br />7-his Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid`:tates pursuant to tlx: <br />revenue laws of the state of Nebraska. Notice is hereby given thattexes incltutina petntkies sod interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes comtitute. <br />a lien in tfie county for real and persvtnal property belonging to the taxpayer tx hereaf/eraequired. - <br />lax <br />Catagpry Taz Period ADstasunent i <br />Number ~ ~ <br />Amount p <br />t Tex Penrity <br />+ <br />Inta`wt <br />AddiYton <br />Aaarnwtt Dw <br /> 11-~1-~? +hr!a+ <br />G1 ilt-3^-32 ;1-12-83 15.33 ? 5.!]f3 2.57 ?3.1?0 <br /> 92-1?1-8 thrums ~ ~~~ <br />~ <br />^7 ?12-28-83 i4-?.9-83 ! 55.5 5.^!? 7.55 68. Q0 <br /> -G -83 tnru ~___~ ~~ <br />41 I~J3-31-~i3 ~g-3'J-~R3 <br />t 47.73 S.GC i 5.95 ___ 58.58 <br /> - <br />-- <br />X04-t~-83 tP~~ ~ _ _____ <br />Ol '+2-31-`-'3 2-17-~~? 115.on 225,Gn i 34,47 7?5.47 <br /> ~ _~ <br />_~_ _~~__-- ---- - --- - --_ _ --rr-- <br /> i <br /> <br /> TOTAL $ t?25.35 <br />here <br />= na+ac>Y ceft,ty tnaf Ina ntaura5.sv CtaO+rernene o< peyevsv¢ naa tUm plinu witn f.ne fayenue.laY+a pt Eha Stata pt Netiririia in.ln• pNar~ - <br />naticn =~* the amra+n: sn ~~ ae a~se. and ttie +a.paYe+ nas talkep to pay Ma amppYtt dne attar demand. if thts NOtICa-At Stale Taw <br />Lrsafl tp tae,+v i +± sarwc iv <ontinuS ine p, iprf[y ur the itate'S fnterett in the attaCtad prppartY.pf tha tixpaYar. <br />~!~.:r~~_____~.~-___-__ Revenue Aaent 3-2C1-&G <br />Pe e9 `a ~ a TiFle Oita <br />_~_~~~~.._~: Soecia] ~tlent 3-2t?-84 <br />A~tnnesaad Sig tore 'it's Data <br />_. .___... ~._.._._......._ .._._. _. ._-. ... _.. ..... .. .. _.-... __.. ___-.-.____..__.__..e .___..._.~~ <br />NESAASkA OEPAR i xkE N? •?t• ~ Ev ENUt - t#h to ana (eta¢neod Cap+r. ?AXPRVER - P nk CoPy <br />COUNTY OFFICE - CanerY Copy <br />4a947a Fiav. tat <br />5 upe+tedes a-49a-1a Rev. s~au <br />U <br /> <br /> <br /> <br />