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<br />Notice ofStateT ax Lien
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<br />-flead instructions on ...verse .ide
<br />J$<)<:'''1 Security Numbe' J
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<br />-j~::~:;. Socl.l S~"'lty 1 83--0 0 3 462
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<br />'.. i ..----- TAXPAV!:""R NAME ANO MAILING ADDRESS -------1
<br />---.-.-.-------.----IN;;m;..-...-- ---.----------,.-----.-------
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<br />1liUl.)t-"---.....-..--~-.--____l-H~.i1~_ COl:!]?:!:n!ctlQDcJdtm.Q~__.______..____
<br />IStr~t ~)r,'Ott1'er"MalHn9' }..\ddreSS-
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<br />' St.at:e- " ~~H::t Code lC'ity State Z,iP Code
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<br />-' S!:~fld .ltl.gJlqJl,~__.....Nf.___......_.__..._..__.__....,2~J~Q1__....___J..@.t.s~5LJ.~1.~.nQ.l._._..._.._._!tL...__________. 6880L_
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<br />This Notice of State Tax Lien is is''lUed by th~ Nebraska l><;,:pllrtment ~)f Re\'elllle for unpaid taxes pursuant to the
<br />R\-"enue laws of file Stlltt' of Nebraska, Notice is hereby gillen that tIIxes including penalties lJnd inte~st < which are
<br />sl:lown below, are due from t.he taxpayer specified ahove !lnd remain unpaid after demand. These taxes constitute
<br />a lien in rhe I~o(jnt}' for realllnd persoual pr(lperty I-1.elonging to the ta.'<:payer or hereafter acquired.
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<br />0..,<<> of
<br />A_em
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<br />Amount of Tal<
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<br />P.""ity
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<br />lnttl'''''t
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<br />Additionll
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<br />Balance of
<br />ASSOlSsment Due
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<br />.~.......-......""""'----._--,""-".,.....,'"'^._""'",...,'~_"'""_._..,'_''''''''~.~""~o~"'_,"'..""',~''''''~''_..__>''",.,''",.,_.,~~"'''~,_..." ,~,
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<br />TOTAL $
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<br />!')~'o,iHtmaf-lt H( H~v~n~J~ hJ~ \.Ofll:l)1i(!J.;J watl the f(!<V~fhHi l>Aw)j. 4,)1 ~he' Stat~ lJt N$bf,IJjp\~1 It'i ttH~ dettlf.
<br />t.lf\' ))u~. \~n4 ti1_iIjIf t~iI,P4YtH HU {,i.!tol1,j ~o Poity ilrHQ,iJnt (lue ilftt'lf t1U!TI.;l,ln<l. It tnl'l Notice of State T.ax
<br />;i~,HI t~ ~,'$, iv (.()()~jfHaJ H~t1:' IU!l;HHy 01 Uu, ?t{a:tw'j; jnt"1ff$~t ifj H'\~ 4Hill!(:urd Pf(:)Pl)rty 1\lf the: taxpayer.
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<br />6-28-83
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<br />COpies
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<br />TAXPAYER ..' P,nk Copy
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