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<br />lf~`d'R[JC'Tl~N1i~ <br />Pt,€RPip +DF Fd}RM. 7h~ farm is [a taa u~d -6~+ tlta Naklrasl[e <br />I2~parem:nt of Revenue i'vr thr purpa of natlfying the appropriate <br />ca~nt~ authorities that a ivatioa of Stata Tsx lion is being filed <br />against the taxpayaa.inil[catad an xhis form. <br />The tax category number caries anai the NeErraslca tax programs that <br />eapraaent ate 3'ucec!'belaur. <br />Ot ... : ..................... . ....Safes Tax <br />t3? .........................Retailers Use Tax <br />Od ............... _ ...... Eonsumars Use Tax <br />10 ............................Parianutuel <br />2I . ..................Income Tax 1Vithholding <br />'? ...:....... Individnaf;Income Tax <br />- 23 .....................FicLciary Income Tax <br />24 ...........Corporate Licome tnd Paitohiaa Tax <br />a'6 ..................:Documontary Stamp :"ax <br />S4 . ............!aiechanicai AmusamentI)evica Tax <br />~5 ..........................SaveraztceTax <br />.................... . ....... Fstata Tax <br />4? ...........................Cigarette Tic <br />67 ......... . ................... Littar Fee <br />(iF3 ........................... f.odging Tax <br />?i .............Interstate Aiotor Carriars Fuel Tax <br />8I ....:. - - ...MatatT,+'ehic3eFael_ImparxingDealer <br />85 ..........................Aircraft Fueis <br />91 ...................... Sgerial Fuels <br />J , P <br />r.. w <br />lt. /t. <br />`` ~ M <br />j <br />t~' <br />~ ~ <br />i <br />a rte` <br />~'a, <br />_J <br />0., <br />Y ~y <br />,~ .,.w,~ ~Ty _J <br />~ s .; <br />ti v <br />~ ` <br />~~ <br /> CO.. cr to <br /> !V ®-+ <br />rn <br /> <br />"f <br />T ~ <br />~ ~ ~ ~ <br />~ <br />nr <br />~` ' <br />-~ p 1 <br />S <br />:'D <br /> <br /> <br /> <br /> <br /> <br /> ~a <br />~.e~V ~ <br />\~. <br />S <br />f`~ <br />~ Fv ~. <br />. <br /> ~~ ff 1 <br />11 - <br />i ~ <br /> C~'i w.k. i i M <br />Z <br /> o. <br />~~ ~~C~ <br />t -' <br />~. <br />