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<br />. ~ne~r.sk. <br />.. ... .'-'d~. a,tt.m..e"l <br />of revenue <br />Wen Serlal- NlJmbe~ <br /> <br />Notice of State Tax Lien <br /> <br /> <br />Lien Type <br />g] Original <br />0' ,.0 _Re,newal <br />County <br /> <br />Date <br /> <br />. Read instructions on reverse side <br />Social Security Number' <br /> <br />11-16.-83 <br /> <br />505-50-6383 <br /> <br />83'-"006216 <br /> <br />Hall <br /> <br />Lien Flied With Spouse's Social Security <br />g}, Register of Deeds Number <br />gj: County Clerk <br /> <br />BUSlj\JESSNAME AND LOCATION ADDRESS <br /> <br />TAXPAYER NAME AND MAILING ADDRESS <br /> <br />watton Glass <br />Streef"Address- <br /> <br /> <br />Name <br /> <br />Ci_ty <br />Graod Islaod <br /> <br />State <br /> <br />Zip Code <br /> <br /> <br />State <br /> <br />Zip Code <br /> <br />NE <br /> <br />68801 <br /> <br />D r <br /> <br />K <br /> <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid tax~ pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties aud interest,which are <br />shown' below. are due from the taxpayer specified above and remain unpaid after demand. The"" taxes colIStitute <br />alien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br /> <br />Tax <br />Category <br />Number <br /> <br />Tax Period <br /> <br />Date of <br />Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Additions- <br /> <br />Balance' of <br />Assessment Due <br /> <br /> <br />03-01-83 thru <br /> <br />TOTAL <br /> <br />$ <br /> <br />,'ih1 1q <br /> <br /> <br />RpvpmlP Agpnt <br />TI!'. <br /> <br />11-1 h-R1 <br />Ditte <br /> <br />Sped a 1 Agent <br />Title <br /> <br />11-lfi-R3 <br />Date <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />N~RASI(A- DEPARTMENT QF REVENUE - White8nd Goldenrod Copies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Canary Copy <br /> <br />4.494-74 Rev. 7.81 <br />Supersedes 4-494.74 Rev. 5.80 <br /> <br /> <br />u <br /> <br />L <br /> <br />..J <br /> <br />L <br />