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<br />I.. .... R..:...,n...~..ra.sk..a <br />artment <br />, 6hevenue-, <br />LIen 'S8:daf Number <br /> <br />I" <br />83';;" Of162fi3 <br />Notice..ofStateTaXl.:.en <br /> <br /> <br />.".;';'~' :\':;; <br /> <br />Island. <br /> <br />NE <br /> <br />Zip Code <br />68801 <br /> <br /> <br />Name <br /> <br /> <br />. Re8d'jnistruction.-on :',ev.,... aid.- <br />Date SocIal Security' Number' <br /> <br />11..,22-83 <br />L.ien FIJed-With Spouse's-Socfal security <br />l>>jtegistel'. Of' oee~s Number <br />Ha 11 gj} County Clerk <br />BUSINESS NAME AND .tCfCATIONADOllESS <br /> <br />Dos <br /> <br />Street',or <br /> <br />State <br /> <br />P.o. <br />City <br /> <br />This Notice of State Tax Lienis issued by theNebraskaDepartmentofRevenueforuDpaidtaxespllriUaittt~the; <br />revenUe .laws. of the sta!e of Nebraska. Notice is hereby given that taxes including penalties and .b.t~t\ ~~ <br />shown. below, are. due from the taxpayer specified above and. remain unpaid 'after deman";Th~ ;taX~. co~tu~ <br />a,lienin the county for real and personal property belonging to the taxpayer or hereafter acquired; <br /> <br /> . . . ' ..... <br />I. Tax Oat80f f3.I~I'f'... I <br />Ca1tmarv T <:x- Period Amount of Tax Panalty Interest Additions- <br />Number Assessment A.........nt!),;. .., I <br /> 04.01-83 thru .. <br />21 U6':'30-83 10-25-83 1339.54 200.93 58.57 .. 1599"04 .. <br /> 06-01-83 thru ... <br />Ol 06-30-83 10-25-83 1361.75 48.14 71. 05 1480.94 <br /> 07-01-83 thru <br />01 07-31-83 10-25-83 1711. 97 52.95 58.45 1823,37 <br /> 08-01-83 thru <br />Ol 08-31-83 10-25-83 1444.41 44.67 32.13 1521.21 <br /> - <br /> TOTAL $ 6424.56 <br /> <br /> <br />Date <br /> <br />Special Agent <br />Title <br /> <br />11 ~22-83 <br />Date <br /> <br />'NI;BRASKA.DEPARTMENT OF REVENUE - Whi.. and Goldenrod Copi., <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 />u <br /> <br /> <br />L <br /> <br />-.J <br /> <br />i <br />t <br /> <br />L <br />