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Itet?Ta5r(A <br />~~irrCpartmant <br />1~tr<ea . <br />Notice of State Tax Lien <br />a Road instroctions on reverse side <br /> <br />t.len sertal Number <br /> <br />2{02{5b5 <br />Llan Type <br />~~rlYinal <br />~ neneWal <br />bate <br /> <br />2-25-82 - _.__. <br />5oclal Security Number <br /> <br />505 80 1750 _ <br />~ ~f ~ 7 ~ "( <br />N<trraska 1. D. No. <br /> <br />3764982 County <br /> <br />Hall Lien F71<d With <br />~i. Ra9ister nt Deetls <br />JCcopnty clerk Spouse's Social Security <br />Number <br /> <br />1 ~~ ~ <br /> <br />_ <br />$USINES5 NAME AND t.OCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS ~ <br />9usinCis Name <br />SDrav P' Name <br />Rod <br />ne <br />L. Glvnn <br />street Atlorass <br />3i7 Narth Vine Street or <br />234 Other <br />iVor Mai ring Adtlress <br />th White <br />_ <br />City State ZI pCotl< City state Zip Code <br />__ brand Islan~h~E 68801_ Gra nd I sland._ NE 68801 <br />This Notice of State Tax Lien is issued by the Nebraska Uepaatment of Revenue for unpaid razes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes inclu~ing penalties and interest, which 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 acyuved. <br />Tax <br />Category ~ Tax Parigf Date of <br /> <br />Assessment ~ <br />Amount pf Tax i ~ <br />Penalty I <br />interest <br />Additions <br />I $alanpe of s <br /> <br />Assessment Due <br />Number ~ <br />17-1-81 thru ~ I <br />i -31-81 8-5-81 72..75 ~ 5.00 4.97 82.72 <br />-1-81 thru ~ ~ I <br />' - 1-81 1-29-82) 18..91 i 5.00 1.07 24.98 <br />19-1-81 thru <br />! <br /> <br />~ 1--'_9-82~ l$.9i ~ 5 00 g4 I 24.75 <br />- <br />~~1-81 thru <br />~ <br />- - - 18 91 ~ 5.00 .63 24.54 <br />!11-1-81 thru _ ~ ! <br />O1 I11-30-81 1-2 -82 18.91 ( 5.00 ~ .41 ~ ! 24.32 <br />12-1-81 thru ! I <br />~ <br /> <br />- - <br />- - 1 ! 5.00 .18 ~ 24.09 <br />- <br /> ~ - i i <br />~ <br />TOTAL I S 205.40 <br />I hereby Certity ;hdt the N<braska Department pf Revenue Fes cpm plietl with the re ue laws of the State of N<braska in the deter- <br />mindllOn Of the dmOUnt SnOWn a tlUe, antl the Caxpdye; has failed FO pdy the dmount tluC dite/ tlemand. 11 Cnis Nptlpe of 51d[e Tdx <br />Lien is an extension of an effei:tive hen it serves to Continue the priority of the s;ore's interest in the of fectetl pro Verty pf the taxpayer. <br />Slgll ~~~ [~ kevenue Agent ~ -25 - ~'y' <br />~~~~ preparor's 53 ute Title ~ Oate <br />-,~..._.s _.__ <br />_ Special Agent ~ -~,; =$? <br />" T Authorized sign re Title Uate <br />FOR COUNTY OFFtGAL'S USE <br />n EBRASKA-DEPARTMENT OF REV ENUE -White and Goldenrod Copies TAXPAYER -Pink Copy <br />a <br />COUNTY OFFOCE -Canary Copy <br />4-494-74 Rev, 7-el <br />supersedes 4.494-74 Rev, 5-a0 <br /> <br /> <br />