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<br />r <br />nebraska <br />department <br />(.w <br />Notice of State Tax Lien <br />• Read in,truetinr,s nn rwvarsa ,iM <br />Llan Serial Number Lien Type Date Social Security Number <br /> OrI91na1 <br />4 04 917 ^ Renewal a_13-84 A <br />~ <br />Nebraska !.D. No. County Llen Filatl With Spousa'3 Social Security Q~~ <br />64~n-i~ <br />.t~_ <br /> ~ R°y"t°' °' D.etlsi NUmber ; <br />31 E4144 Nall ® County Clerk <br />OWtneaC name XteV LVLM t rVn nuvn ca0 XnY MMtL1}eV a,VYrf eaO' <br />(?pfinesf Ndme Name <br />8oltzs Market Inc. _ Boltzs Plarket Inc. <br />Street Atltlrefs Street or Other Mallin° Atldrefs <br />City State Zfp Cotle City State Z16 COda' <br />brand Island, '!E 58801 ___ Grand Island, ^!E 58841. <br />This Notice of State Tax Lien is issued by the Nebraska L)epartment of izevenrfe far unpaid laxp pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest; which sre <br />shown below, are due from the taxpayer specified above and remain unpaid after demand, These taxes corotihtte <br />a lien in the county for real and personal property belonging to the taxpayer a hereafter acquired. <br />Yea <br />NCatMaW <br />7aa Period Dan of <br />Ataessmtatt <br />I Amount of Tax Penalty <br />Interest <br />AtWitiot3s gam. <br />Atanrnseter Cue <br /> <br />O1 06-O1-83 thru <br />06-30-83 <br />1-4-84 <br />1 275.93 i g.56 <br />1 27.83 <br />312.32 <br /> <br />O1 07-01-83 thru <br />07-31-83 <br />1-4-84 <br />227.79 ~ 7.05 <br />20.27 <br />255.11 <br />I <br /> <br />} I ~ ~ <br />;- <br /> <br />i - - <br /> ~- <br />I <br />i <br />TOTAL , $ 567.43 <br />I hereby certify that the Nabra3ka Department °t Raven ue ha3 complietl with the revenue laws O( the State OI Nebraska in the tleten ^_ <br />urination of [Rd atnouni mown t° De pus, and [ne taxpayer ha3 failetl to pay the amount tlw after demantl. If [Rif Nollce bf Stara TdX <br />Lien IS j/,,~ex2Mfibn Of an effQptive hen it serves t0 cpnl~nue the priority pl the 3[a[e'3 IntOfefl In the affectetl property of the [iapaYel. <br />~~;~+~,""f'ry',e~j ~~ 2evenue Agent 4-13-84 <br />~Pr~ar gnai~ TI<ia Dats <br />r~ _,_ Special Agent 4-13-84 <br />'AUtnoiiaed S ture Title pate <br />• FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE -~ White and Goldenrod Copies TAxPq YER - Pink Copy COUNTY OFFICE -- Canary Copy <br />a-a941a qev. 7.81 <br />~upersebe3 Y~a94-76 Rav. 5~8U <br /> u <br />~ ~ <br /> <br />