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INS'i'ftt3CTl6?NS <br />PURPOSE OF FORM. This farm i; to tae used by the Nebraska <br />Department of Revetrue for the purpose of notifying the appropriate <br />county authorities that a Notice of State Tax Lien is being filed <br />against the taxpayer indicated an this form. <br />The tax category number codes and the Nebraska tax programs they <br />represent aee listed below. <br />Dl .............................SalesTax <br />D2 ........................Retailers Use Tax <br />Q4 . . . . . . . . . . ............ Consumers Use Tax <br />1D ............................Pari•mutuel <br />2T . . .. . . . . . .......... Incame Tax Withholding <br />22 . . . . . . . . ... . . . ...... Individuai Income Tax <br />23 . . . . . . . . . . . . .........Fiduciary Income Tax <br />24 ...........Corporate Income and Franchise Tax <br />Documentary Stamp tax <br />3ti ................... <br />4q , , , . , .......Mechanical Amusement Device Tax <br />45 ..........................Severance Tax <br />. Estate Tax <br />46 ........................... <br />47 ....... . ...................Cigazette Tax. <br />Litter Fee <br />57 ............................. <br />6g ...........................Lodging Tax <br />71 .. . ..........Interstate Motor Carriers Fuel Tax <br />g l ...........Motor Vehicle Fuels Importing Dealer <br />85 .........................Aircraft Fuels <br />Y i ...... ... .. ... .. . ..... .. .. . .ipeLiai uciu <br />!~ <br />~ ! <br />. ~ ~ ~ ~/ <br />~ ' <br />t..: <br />I <br />L~~ <br />x ~ <br />m <br />cs i' <br />o <br />T <br />O <br />:"+l <br />fa't ~ <br />n <br /> <br />v <br />~ ~ oy <br />rrs O -/ <br />•'*'1 + A <br />~ <br />'` <br />+ <br />rn <br />PTA <br />® =a rn " <br />~ <br />N ~ <br /> -~ o is <br />n,- o -n <br />-~ ~a ac ~ ai_ <br /> i <br />k++!"s i ~ <br />c <br />~ 01 <br />~~ ~ ~ ~.. <br />O ~ ~ <br /> <br />_ a? <br />_~ ~ <br />~~ <br /> <br />rv N ~ 3 <br /> <br /> O <br />~~, ._. <br />r°-yam,.\\~\ <br />P P <br /> <br /> <br />