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rlus~RUC~ion~s PURPOSE OF FORM: This form is to be used. by the Nebraska Department of Reventie for 4hepvrpose of notifying the appropriate county authorities that a Notice of State Tax Lien is being filed agairtst the taxpayer indicated on this form. The tax category number codes and the Nebraska tax programs they represent are listed below. 01 ....... ...................... Sales Tax 02 ....... .................Retailers Use Tax p4 ....... ............... Consumers Use Tax 10 ....... .....................Part-mutual 21 ....... ............Income Tax Withholding 22 ....... .............Individual Income Tax 23 . . ..... ..............Fiduciary Income Tax 24 ....... ....Corporate Income and Franchise Tax 36 ....... ............Documentary Stamp Tax 44 , ...... .....Mechanical Amusement Device Tax 4S ....... ...................Severance Tax 46 ....... ..................... Estate Tax 47 ....... ....................Cigarette Tax b7 ....... ......................Litter Fee 68 ....... ....................Lodging Tax 71 ....... ......Interstate Motor Carriers Fuel Tax 8I ...... .....Motor Vehicle Fuels Importing Dealer 85 ...... .................... Aitctaft Pueis Cy ;`~ (,. v~ \ \~ ~\ ~~~ (`" ~' \ ~~~ ~ A ~`~". ~ ~~ ~ ~ M1 ~ h ~ ~'„° `h "; , h ~,. 41~ ~r t..,_._ as {"~ `OI m ~ c~ ~ b r ~" ~i o rn r+r 4 n 'n .. o~ _ rre cn z "m Qp ~ _ ~ ~ -` N `~ 't " z c~ a ~.. -' tv . j c m r n ~... p. ~ ~ 4 co 'S , ~ t7f c .~ ~ ~ .~ y ! (p „1 rn .. ~ -_~. 41 Z b ___.