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<br />NatiGe of State ~'ax Lien
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<br />1 174_x, Fatnal
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<br />L, BUSINESS NAME AND LOCATION N.~DRE~ ~ _ _ -TA)IPAVER NAME AND MAILlNCa O,ODRESS J
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<br />'thI>a tca4i~c# of St~te.'3'ax Lien is icitfccl Dv [hr ticim3sk:~ L'r~rAn2at ~i Re.enur far a-npaid taxes ptusuant m the
<br />sc'cntne lisfws txf C~ts~ffile ~t 5ehravky_ tii~ti^~e i~., flere9r~ Fjvrn th=e ~,ces including Exraliirs arul ir~tirest,t<~hich are
<br />abrnwn below, arcduc Ecn~m vt ixp~~er;f*ecift~i shove and remain unpaid aftrr aemarW. These t3ties .onstihite
<br />a treatio tlxeaantsrf<ir>;eaiattQ ptnnna3~r~peres~ txl~~nging :a the taxpavrr t>c iterea[tcr acr~uin-d. -
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