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<br />I <br /> <br />a. <br /> <br />llrif,nebr.'ko <br />department <br />of revenue <br />Lien Serial Number <br /> <br />Notice of State Tax Uen <br /> <br /> <br />Lien Type <br />~ Original <br />o Renewal <br /> <br />Date <br /> <br />. Read instructions on reverse side <br />Social Security Number <br /> <br />84- 00549B <br /> <br />10-16-84 <br /> <br />506-46-1639 <br /> <br />County Lten Filed with Spouse's Social Security <br />f ~ Regi:;ter of Deeds NUmber <br />3164144 Hall [19 County CI.rk 505-54-3992 <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />Business NaIT'i:: <br /> <br />,N<!tn,.:;, <br /> <br /> <br />TAXPAYER NAMEANOMAILlNG ADDRESS <br /> <br />Boltzs Market Inc, <br /> <br />Jerome & Janet Boltz <br /> <br />Street Address <br />508 East 6th Street <br /> <br />,Street or Other Mailing Address <br />R R 3, Box 261 A <br /> <br />City <br />Grand Island, <br /> <br />State <br /> <br />Zip Code <br /> <br />City <br />Grand Island, <br /> <br />State <br /> <br />Zip Code <br /> <br />NE <br /> <br />68801 <br /> <br />NE <br /> <br />68801 <br /> <br />This Notice of State Tax Lien is issued by the Nebraska Deparbnentof Revenue for unpaid taxes pursuant to the <br />revenue laws of the slate of Nebraska, Notice is hereby given that taxes including penalties and interest, which are <br />shown ~Iow. are due from the taxpayer specified above and remain _unpnID after demlind.- Th~- taxes:CGusnmte <br />a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired, <br /> <br />Tax <br />Category <br />Number <br /> <br />Tax Period <br /> <br />Date of <br />Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />Addi-tions <br /> <br /> <br />06-01-83 thru <br /> <br />01 <br /> <br /> <br />01 <br /> <br /> <br />TOTAL $ <br /> <br />I Oereby certify that the Nebraska Oe~aftment of Revenue has ccmp!ied with ttle revenue laws of the State of Nebr.sk.a In t:hq ~t_...- <br />mination Of the amount snown to De due, ana the taxpayer has failed to pay th& amount due after demand. If thts Notlf;e-of 5t4to Tax- <br />. Uen is :". extension of an effttC~i"e ~_n..~t serves to continue the priority of the state'$- Interest [0 the affected property- o. f. the,t~y_~.... <br /> <br />SHIft.;; l/J'7/ . ..... <br /> <br />.... .~~ ~ Revenue Aqent .1\H6~8-r/ <br />here eo.,.,', s,~ ,_ /} _~-~ ;i T1.':'! OIct... <br />. . . L-~~u"'J ~ 't--7~ Special Aqent .10-J6;.84,. <br />Authorlzed Sf9natu ..- Title Date- ~. ' <br /> <br />FOR COUNTY OFFICIAL"S USE <br /> <br />J <br /> <br />NEBRASKA DEPARTMENr OF REVENUE - WM. and Golden,ad Copi., <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Cana(V Copy <br />4.4~4-74 R.II~ 7-8_1, <br />Supersedes 4-494.14 Reli'~ 5.80 <br /> <br />u <br /> <br />L <br /> <br />-1 <br /> <br />L <br />