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<br />Ir;ebraska <br />department <br />of revenue <br />Lien Serial Number <br /> <br />Notice of State Tax Lien <br /> <br />Nebraska I.D. No. <br /> <br />LlEln Filed With Spouse'S Social Security <br />19 Reg'ster of Oeeds~!'52_6743 <br />Kl County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br /> <br />Lien Type <br />[2J Original <br />o Renewal <br />County <br /> <br />Date <br /> <br />. Read instructions on reverse side <br />50c;31 Security Number <br /> <br />2-25-84 <br /> <br />5.00 <br /> <br /> <br />lnterest <br /> <br />4110/667 <br /> <br />10-22-84 <br /> <br />507-54-4699 <br /> <br />84-- <br /> <br />3534847 <br /> <br />Hall <br /> <br />Business Name <br />Browns Repair Shop <br /> <br />Name <br /> <br />Street Address <br /> <br />Edmund A. & Sharon <br />Street or Other M.alling Addre5S <br /> <br />West Highway 30 <br /> <br />City <br />Wood River, <br /> <br />State <br />NE <br /> <br />Zip Code <br />68883 <br /> <br />Box 177 <br />City <br />Wood River, <br /> <br />This Notice of Slate Tax Lien is issued by the Nebraska Department of Revenue for <br />.revenue laws of the slate of Nebraska, Notice is hereby given that taxes <br />shown below. are due from the taxpayer specified above and remain unpaid <br />a lien in the county for real and personal property belonging to the <br /> <br /> <br />Tax Period <br /> <br />Date of <br />Assassment <br /> <br />Amount of Tax <br /> <br />Penattv <br /> <br />90.62 <br /> <br />15.81 <br /> <br />85.01 <br /> <br />11. 86 <br />c (l1;_,+~s~4 <br /> <br />85.17 <br /> <br />TOTAL <br /> <br />$ <br /> <br />307.31 <br /> <br />sign <br />here <br />~ <br /> <br /> <br />I hereby certify that the Nebraska Department at Revenue has complied with the revenue laws ot 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 Stllte T~x <br />Lien is an extension of an effectiv lien It ser",es to continue the priority of the state's interest in the affected property of the taxpayer. <br /> <br />Revf>nuf> Agent <br />Preparer sirr6 ./ tJ &_'"'i ;_~? _~ TltIe <br /> <br />C'-<~.....~'" <...,,:4;--5.J,p-- Special Agent <br />Authorized Sign ~ ra / Title <br /> <br />FOR COUNTY OFFICIAL'S USE <br /> <br />10-22-84 <br />Data <br /> <br />10-"2-84 <br />Date <br /> <br />NEBRASKA DEPARTMENT OF REVENUE - White and Goldenrod Copies <br /> <br />TAXPAYER - Pink Copy <br /> <br />COUNTY OFFICE - Canary Copy <br /> <br />4--494-74 Rev. 7-81 <br />Supersedes 4-494-74 Rev. 5.80 <br /> <br />u <br /> <br />L <br /> <br />..J <br /> <br />L <br />