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<br />I <br /> <br />IIs""brnk' <br />~rtment <br />.. .. ohev.no. <br /> <br />Notice of State Tax Lien <br /> <br />r <br /> <br />DISCHARGE OF STATE TAX LIEN <br />INDIVIDUAL INCOME TAX 84. . _n.nAf~O <br />. v~"Vy <br /> <br />I <br /> <br />IF YOU INQUIRE ABOUT YOUR <br />ACCOUNT, REFER TO THESE NUMBERS: <br /> <br />SOC. SEC. NO. <br />NEBR. IUEN'!. NO. <br />SPOUSE SOC. SEC. NO. <br />TAXABLE YEAR <br />LIEN NO. <br />LIEN RELEASE NO. <br />COUNTY <br />DATE OF NOTICE <br /> <br />505-78-8992 <br />22862854 <br /> <br />DOUGLAS A. POLCHES <br /> <br />1979 <br />84055034 <br />84214244 <br />HALL <br />08-01-84 <br /> <br />1024 SOUTH PINE STREET <br />GRAND ISLAND, NE 68.801 <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br /> <br />o/...71.~4 <br />....,.. '...,.'~-.,-._. <br />DAT <br /> <br /> <br />. . fl:?:~t . .. <br />DATE <br /> <br />PURSUANT TO THE REVENUE L.l\.WS OF THE STATE OF NEBRASKA, NOTICE IS:c <br />HEREBY GIVEN BY THE NEBRASKA DEPARTMENT OF REVENUE THAT THE:NOTI~ <br />OF STATE TAX LIEN WHICH HAS BEEN DULY FILED AGAINST THE ABOVE~~: <br />TAXPAYER FOR INDIVIDUAL INCOME TAXES IS DISCHARGED; <br /> <br />I HEREBY CERTIFY THAT THE NEBRASKA <br />WITH THE REVENUE LAWS OF THE STATE <br />OF THIS DISCHARGE. <br /> <br />t-. 01. _ . c p." <br />.~.~ <br />PREPARER'S SIGNATURE <br /> <br />/) . a ./ <br />...~~...:~.. <br />TITLE 0..... <br />T';~'~' <br /> <br />~,r--~, ~. <br />! (L:. .1' <br />/~/ . <br />AUTH ZEDSIGNA~JtE <br /> <br />C==~--"---"'-'---'~""~NEiiR:iSi~-oE'F~RTMiNT-oF-R'eveNuE"O-FF'ices ___________~-==:J <br /> <br />It lP'>:'U l'4I..." -i)"~ Q",e$tio;'$ .e')lr\1JnG. t1\i~ n-ot:-c~. "Je4'e ..o_ntii.:t l~e N.broil;Si<./t Dl!p,artmwt 0' R.e'lanua, 60x 94815. l,.l-n(;uln, N.b'~~~ ~8~09. Of ~.ny .ut <br />!n<l re9ion.a1 qfH;:;as tI$tei:l C$IO-~'. '<I N.t.u4$-J.la ~Oi..l may "hn !..Ii,)l t~ji> f~~. 'i~)",I lQf\-g ~1$U,n'e -i::.cen number and 8QO.742-7414 for 4ui$tolnc.. <br /> <br />~ <br /> <br />lINCOl.N 1~21.1'-291' <br />QtAAl<A - 1<1021 5!;.t,206S <br /> <br />GRAND ISLAND - 13081384-6629 <br />NORFOLK - 1.02,371,'620 <br /> <br />NORrH PLATTE - 13081532~O <br />scons BLUFF - (308/632<3831 <br /> <br />NEBRASKA DEPARTMENT OF REvENUE Whjt/t <inti Can,JJ Y Cop,'rt~ <br /> <br />TAXPAYER PInk Copy <br /> <br />COUNTY -. Goldenrod CoPV <br />7.14$.19 <br /> <br />L <br /> <br />L <br /> <br />..J <br /> <br />L <br />