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a a .* <br />i Nebraska <br />department <br />of revenue <br />Plofice of State Tax Li~r~ <br />•Raad instructions on reverse side <br />t:len.Serlat Numixr Lien Type Date Social Security Number <br /> Or79inal <br />2/021480. ~ Renewal 2-18-82 458 50 8099 ~ <br />~+~1 <br />ry <br /> <br />Nebraska 1.0. No. <br />County <br />Lien'F{letl with <br />SPA450 `s Social 58curity / <br />s, <br />/ <br />6 ®~ 4 ®~ <br /> Ra9ister of Deetls Number V <br />~J <br />3064654 Hall [~ County Clerk <br />BUSINESS NAME ANO LOCATIGN ADDRESS TA%PAVER NAME AND MAILING ADDRESS <br />Business Name Name <br />_ brand Island WeldSng 4tile Sandlin <br />Street Atldres5 Street or Otner Ma(lin9 Atldress <br />_ 3244 Bachman Route 1, Box 57 A2 <br />City State Zip Code City State <br />Grand Island P7E 68801 St Libory, NE <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant 4o the <br />revenue Saws of the state of Nebraska. Notice is hereby gven that taxes including penalties and interest, whih are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />alien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Category <br />Tax Period Data of <br />Assessment I <br />~ Amount of Tax Penalxy ~ <br />Interest <br />Additions Balance of <br />Assmsment Due 1 <br />Number <br /> -T-81 thru <br />~ <br />~ <br />OT -30-81 9-30-81 5.00 <br />156.53 13.99 ~ 175.52 <br /> -I-81 thru <br />01 -30-81 2-15-82 38.32 5.00 1.62 44.94 _ <br /> i-1-81 thru <br />21 3-3i-8i 7-22-81 -C- 10 27 3.08 13.35 <br /> -1-81 thru <br />21 6-30-81 9-29-81 120.69 12.06 10.79 143.54 <br /> 7-i-81 thru <br />21 9-30-81 2-15-82 159.43 3i .89 6.73 ~ 198.05 <br /> I <br /> -~ ~ -- - <br /> TOTAL (S 575.40 <br /> I hereby certify that the N ebraska Oepartmant 0( Revenue nos complied wi[n the revenue laws of the State of Nebraska in the tleter- <br /> nlindtiOn.Of the amount Show n to be tlue, antl the taxpayer has falletl tU pay the amount due after demantl. If Yh iS NoticO of State Tax <br /> Lien IS do ext¢ns10n Of an eflf lri' le lien it serves to COniinue the pft0lity of Lhe state's Interest in the d}}QCted Dro petty of th¢ taxpayer. <br />sign ~ + Revenue ADent ~ ~~-~~- <br />~~1~ <br />i ~ Prep i9r'S Si re f <br />v..~,.v /' ~ Title <br />~C_ °""'~ Sneci al Agent Date <br />~ -! ~ " ~~ <br /> ~~AUthorized Sign re Title Daxe <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REV ENUE -White and Goldenrod Copies <br />TAXPAYER -Pink Copy COUNTY OFFICE -Canary Copy <br />4-494-74 acv, ]-81 <br />Supersedes 4-499-74 Rev- 5-80 <br /> <br />Zip S:ad <br />68872 <br />L....... <br />