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<br />Lien Serial Number Tuen Type Date ISOCla! Secu"'y Numba' <br />4/08/456 UOriginal 8-10-84 472-48-5479 <br />1 0 Renewal <br />Nebraska 1.0. No, I ~~;t{ L"len Filed With lspouse's Social Security <br />4254422 8J Register of Deeds Number <br /> KJ County Clerk I <br />r BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAIliNG ADDRESS I <br />Business Name Name <br />Courtesy Court Motel DeWayne R. Mickle <br /> --- Stroot or Other Mailing Addre$s <br />Street Address <br />2301 West 2nd 36 West 104th Street <br />-' state ZJp:Cod. <br />ru" ~t:>t.. Z!n Code CHu <br /> <br />I <br /> <br />lr;;,eO,"Sk' <br />department <br />of revenue <br /> <br />Notice of State Tax Lien <br /> <br />. Read instructions on reverse side <br /> <br />r <br /> <br />Gra nd Island, <br /> <br />NE <br /> <br />68801 <br /> <br />Bloomington, <br /> <br />MN <br /> <br /> <br />84 - 004219 <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes cpursuant:tothe <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties-aildinterest;;Whkhare' <br />shown below, are due from the taxpayer specified above and remain unpaid after. demand, These taxes ,constitUte <br />a lien in the county for real and personal property belonging to tbe taxpayer or hereafter acquired; . <br /> <br /> <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />tnterm <br /> <br />108.98 <br /> <br />5.00 <br /> <br />210.49 l -0- <br />-1-- <br /> <br />01 <br /> <br />175,10 <br /> <br />5,42 <br /> <br />68 <br /> <br />87,74 <br /> <br />5.00 <br /> <br />68 <br /> <br />157.87 <br /> <br />5.00 <br /> <br />21. 25 <br /> <br />120,07 <br /> <br />5,00 <br /> <br />14 74 <br /> <br />68 <br /> <br />TOTAL <br /> <br />I nM1l:Dy cer'1ify that tne Nebr.uk.a Di!P3rltYlellt of R.9';/enue has complied wIth the re....nLl. laws of the State of,N_bnlska lnA:6.;Qieter:-+ <br />n~,nat.ion of the amount sr.own to bo:, due, ana t!le [';&l<P<1-lICf 11,<1-$ tailed to pay the amount due after dem.nd. If thls NotlC.,9f,s~t~>Talt <br />Lll:'1n IS <lIfl e><:tenslon vI an efte<:.ti;f>J- hen I~ s-:rves to c__otHinue- the priority of the state's intarest in the .,ff4tCted propart)t,of,-t-h.:t~~Yilf!~ <br /> <br />sign <br />here <br /> <br /> <br />Title <br /> <br />Revenue Aqent <br />Special AQent <br /> <br />NEBRASKA DEPARTMENT OF REVENUE '-. Woite and Goldenrod Coples <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFIC.. ~ Canely. COpV, <br />4.494-14 Rev. 1--61 <br />Supersedes. 4<494.74 Re..:. 5.80 <br /> <br />-~----,---~_._------~~--'~-----~-,..,---~----_.,-- <br /> <br />L <br /> <br />L <br /> <br />I <br /> <br />L <br /> <br />L <br />