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I lI~ebra'ka department of revenue Notice of:State Tax Lien Lien Serial Number Lien Type Date Social Security. Number [)j OrlqJnal 6-19-84 520-34-2660 4/06/236 o Renewal "' 003247 Nebraska 1.0. No, County Lien Filed With spouse'$: Soclal-Securlty- 84 ...... KJ Register of Deeds Number 3614123 Hall I ?l County ClerK 505-60-4103 I BUSINESS NAME AND LOCATION ADDRESS I TAXPAYER NAME AND MAILING ADDRESS I Business Name -IName -Read instructions on reverse-side The Beehive Street Address I A Brlckner FOR COUNTY Off ICtAL 'S USE Zip COde State Zip Code 1739 South Ingalls City Grand Island State Grand Island NE 68801 NE This Notice of State Tax Uen is issued by the Nebraska Department of Revenue for unpaid taxes 'pursuanHo ,the revenue laws of the slate of Nebraska, Notice is hereby given that laxes including penal!iesandinterest. which are shown below, are due from the taxpayer specified above aud remain unpaid after <himanet, These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired: Tax Period Date of Amount of Tax Penalty Interest Additions Assessment [12-01-82 thru ~ 102-28-83 _, -0- 10.00 6.14 103-01-83 thru T ~ 103-31-83 i 06 46.77 5.00 8.68 104-01-83 thru I 97.88 5.00 14.68 04-30-83 05-01-83 thru 5.00 I 01 i05-31-83 12/23~ 76.56 10.57 ,06-01-83 thru i 12/23/8~ ---r 01 106-30-83 125.41 5.00 15.87 i07 -01-83 thru I I 01 107-31-83 2 14/841 253.41 9.80 33.30 108-01-83 thru I , 01 108-31-83 I 2/14/84 i -0- 5.0~ 1.17 TOTAL $ j t1dreby ce-rtlfy tnat the- Nebraska Department OJ HI;f\'fHHH! thH compiled witn tile revel1ue laws of tne State of Nebraska in the-deter-~ fnmatlOn of r.he Gi'Uount :!OhOWfl to be due, and the \~)(I.>ilyoer IUS r.ailed to pay the amount ou-e after demand. It this,Notice-of Stllt~"Ta)j u.en ,~ an e-l':tO!l1s1Q!1 Of ,Jfl '.lfl!Jctivf: lien n ~{jrvm; to 1;C:'I!inue t!1e ptlorlty ()1 the $tate's interest In the affected property of ttie taX-PIt)!"ar. sign . here ,~ev~ue Agent 6/19/84 ~ rlOe Oate ~ecial Agent TItle 6119184 Oat. I L-.- NEBRASKA DEPARTMENT OF REVENUE WhIte and Gof(j~nrod COP'I% TAXPAYER -- Pino< Copy COUNTY OFfiCE - Canary Copy 4.494.74 A,ev. ',81 Supoe"""Hie" 4,494.14 H..... 5-80 u L ~ L,