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<br />1rJ5.. asII. <br />men. <br />. ....>~rw.~ <br />Uaft's.ft..t Num'b., <br /> <br />Notice of State Tax Lien <br /> <br />83- 004444 <br /> <br />910667 <br /> <br />505-64-5584 <br />L.len Flied With Spouse's Soclat Security <br />t&l Register of Deeds Number <br />Ha 11 IKl Coun,y Clerk <br />I(USINEsS NAME AND LOCATION AOORESS <br /> <br />Lien Type <br />o Origln~1 <br />iJ Renewal <br />county <br /> <br />Date <br /> <br />. And instructiona on reverse ,Mf. <br />Social security Number <br /> <br />f <br /> <br />0-3-79 <br /> <br />Nel'IraSka 1,-0. No. <br /> <br />3103986 <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />amlnoli55 Name <br /> <br />Name <br /> <br /> <br />Da 1 e E. Mercer <br />Street or Other Mailing Address <br /> <br />Cl'y <br />Grand Island. <br /> <br />State <br /> <br />Zip-Code <br /> <br />712 West 11th Street <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />NE <br /> <br />68801 <br /> <br />Grand Island <br /> <br />NE <br /> <br />68801 <br /> <br />This Notice of State Tax Lien is issued by the Nebl'llllka 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 lielow. 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 />r~ Tax Period Date of Amount of Tax 1 Ponalty 1 Interest Additions BalanCti of I <br />-.... ASS8SlSment Assessment Due <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 /> I <br />21 9-30-79 10-3-79 114.52 ! ! 114.52 <br /> I ; <br /> f i <br /> i ! <br /> i i <br /> i <br /> i ! <br /> I I <br /> 1 <br /> i I <br /> i I <br /> I I I <br /> I I <br /> I <br /> <br />TOTAL <br /> <br />I S <br /> <br />410.13 <br /> <br />I hereby certify that t~ Nebruka Department of Revenue has complied with Ute revenue iaws of the State of Nebraska in the deter~ <br />mln4Uon of the amount shown to be due, an4 the ta~pay.r has failed to pay tn. .mount due .Uer demand. If this Notice of State Tax <br />. Wer> IS an ox,.,..lon 01 an :If?~;.n It _.os to con,,"uo ,no p"o"'y 01 tho "a'o', ...tor..' In 'ho alfoc'O<! propo". 01 'M 'axpay.r. <br /> <br /> <br />Slln ~ ~ ) Revenue Agent 8-18-83 <br />here Pr-fip.atel's ~ur. ['1 ~'l ,t Title Date <br /> <br />JJ-:: V Speci a 1 .o.gent 8-18-83 <br />Tttle Date <br /> <br /> <br />FOR COUNTY OFFICIAL OS USE <br /> <br />l <br /> <br />NEBRASKA. OEPARTMENT OF REVENUE - White ond Goldenrod Copi.. <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Canary Copy <br /> <br />4~494-74 Rev~ l~al <br />Supersedes 4-494.74 Reli. 5-80 <br /> <br />u <br /> <br />L <br /> <br />L <br /> <br />~ <br /> <br />L <br />