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<br />I <br /> <br />I riteb,"'. , <br />department <br />of revenue <br /> <br />Notice of State Tax Lien <br /> <br />r <br /> <br />Lien Serial Number Lien Type Date Socia! Security Number <br /> ~ Original 8-17-84 508-32-0399 <br /> o Renewal B4- <br />Nebraska 1.0. No. County Lien Flied Wit!l Spouse's Social Security 004602 <br /> l&J Register of Deeds Number <br />3875148 Hall ~ county Clerk <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I <br />Business Name Name <br />Mr. Luckys Max Barry <br />Street Address Street or Other Mailing Address <br />3311 w. Stolley Park Road 19 Chanti lly Street <br />City State Zip Code City State Zip Cod~ <br />Grand Island, NE 68801 Grand Island, NE 68801 <br /> <br />. Read instructions on reverse side <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are <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 the taxpayer or hereafter acquired. <br /> <br />I Tax Date of Balance of I <br />Category Tax Period Assessment Amount of Tax Penalty Interest Additions AmlSSinent-Oue <br />Number <br /> 01-01-83 thru <br />01 08-31-83 1 792.75 51. 48 319 47 ? ll'>~ 70 <br /> 10-01-82 thru I <br />21 06-30-83 - 336,01 16,~ j.._~ 10 lllA 01 <br /> I I ! . <br /> I I <br /> J---- - <br /> I i -t I <br /> I I <br /> I - <br /> I <br /> I i <br /> i <br /> I , I <br /> <br />TOTAL <br /> <br />I $ <br /> <br />?,5R? fi1 <br /> <br />I heleby certify that the Nebraska Department of Re....enue has complied with the revenue laws of the State of Nebraska In the deter- <br />mination of the amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax <br />Lien is an extension of an effecti....e lien it serves to continue the priority of the state's interest In the affected property of the taxpayer. <br /> <br />sign. ~~ ~ b(~ Rpvpnue Agent <br />h....... Preparer;}:.s+pnature ~ (II Title <br />IIIU.V ( / - d J . / <br />. ~(U~ ~ Special Agent <br />AuthOl1zeU Si tur.:; - I Title <br />FOR COUNTY OFFICIAL'S USE <br /> <br />3-3\ -~~ <br />Date <br />8-3i-~if <br />Date <br /> <br />L <br /> <br />NEBRASKA DEPARTMENT OF REVENUE -- White and Goldenrod Copies <br /> <br />TAXPAYER Pink Copy <br /> <br />COUNTY OFFICE - Canary Copy <br />4.494-74 Re..... 7-81 <br />Supersedes 4-494-74 Re..... 5-80 <br /> <br />u <br /> <br />L <br /> <br />L <br /> <br />~ <br /> <br />L <br />