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lr;febraSka dfWartment of revenue Notice of State Tax Lien r LIen Serial Number Lien Type D<lte Social Security Number 4/09/544 g] Ori9inal 8-31-84 o Renewal 84__ 004690 Nebraska 1.0. No. County Lien Filed With Spouse's Social Security [! Register of Deeds Number 4332474 Hall ~ County Clerk I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS I BusinesS Name Name Dads Li quor South Inc. Dads Li quor South Inc. Street Address Street or Other Mailing Address 1404 South Locust 1404 South Locust City State Zip Code City State Zip Code Grand Island, NE 68801 Grand Island, NE 68801 . Read instructions on reverse side This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are shown below, are doe from the taxpayer specified above and remain unpaid after demand, These taxes constitute a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired, 01 1017.22 Interest Additions Balance-of A$S8S$ment Due Amount of Tax 8-30-84 49.94 1,098.62 r--i TOTAL $ I hereby certify that the Nebraska Department of Rell'enue has complied with the revenue laws Of the State of Nebraska in the defer~ 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 Lien is an extension of an effective lien it servos to continue the priority of the state's interest in the affected property of the-taxpayer. sign ~ '-J~ here ~ p,.p"e,', ~r:!re ,,-,-S-J!.iZ:c:;!/--- ~ Authof~Z8d~ f Title Date Revenue Agent Special Agent Title Date FOR COUNTY OFFICIAL'S USE NEBRASKA OEPARTMENT OF REVENUE - White and Goldenrod Copies TAXPAYER - Pink Copy COUNTY OFFICE - Canary Copy 4.494-74 R"y. 1~81 Supersedes 4.494.74 Rev. 5.80 u L L ~ L