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<br />I <br /> <br />ISneb,aska <br />,dcntartment <br />- 'Of'reve"ue <br />Lien Serial Number <br /> <br />Notice of State Tax Lien <br /> <br />83- 004443 <br /> <br />r <br /> <br /> <br />Lien Type <br />o 0'19ina' <br />.[] Renewal <br />County <br /> <br />Date <br /> <br />. Read instructions on reverse side <br />Social Security Number <br /> <br />10-3-79 <br /> <br />505-74-8328 <br /> <br />Nebraska' 1.0. No.- <br /> <br />Lien Filed With <br />K] Register of Deed <br />3103986 Ha 11 g]Counl~ C'a,k <br /> <br />8USINESS NAME AND LOCATION ADDRESS <br /> <br />Spousa's Social Security <br />Number- <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />Business Name <br /> <br />Name <br /> <br /> <br />City <br /> <br /> <br />State <br /> <br /> <br />Zip Code <br /> <br />Street- Addtess <br /> <br />Grand T!:land, NF <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department 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 taxes constitute <br />a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired, <br /> <br />f Tax Date of I Balance of I <br />Category Tax Period Assessment Amount of Tax Penalty Interest Additions Assessment Due <br />Number <br /> 4-1-79 thru I i <br />21 6-30-79 10-3-79 277.56 13.88 4.17 295 61 <br /> 7-1-79 thru I I <br />21 9-30-79 10-3-79 114.52 ! t 114 !)? <br /> i <br /> i <br /> I <br /> [ <br /> i <br /> I I <br /> I I <br /> i <br /> I I <br /> i I <br /> I I <br /> TOTAL S 410.13 <br /> <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the deter~ <br />minaUon of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax <br />Wen Is an extension of-on effective Hen it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />sign ~~ W~ <br />her,.. .P.,."s~. (() i2 ~-- <br />. -'hI tf-- ~ <br />Authorized 519 ure <br />. ; <br /> <br />Revenue Agent <br /> <br />8-18-83 <br />Date <br /> <br />Title <br /> <br />Special Agent <br />Title <br /> <br />8-18-83 <br />Date <br /> <br />~ <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />NE8RASKADEPARTMENT OF REVENUE - Wnitaand Goldenrod Copies <br /> <br />T AXPA YER - Pink Copy <br /> <br />COUNTY OFFICE - Cana,y Copy <br /> <br />4-494-74 Rev. 7-81 <br />Supersede.. 4-494-74 Rev. 5-80 <br /> <br />u <br /> <br />L <br /> <br />L <br /> <br />~ <br /> <br />L <br />