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Notice of State-Tax Lien <br />neb.aska <br />department <br />of revenue - • Rand inatructfon on raaarp Mda <br />- UM Serial Numper Uen Type ! Aau _ SoCtal SKUrity NLLmflar - <br />Originsi ! 1 ~ .z <br />2/10/509 ~IRenaWrl ~o-21-a _?_L_ 82:=, OQ460$ <br />- NtDras%a I.G. No. County I ltan_ F(IeC with SpoUZe'S $oGal SacW{ty- _ _ <br />Register of Deetl NUrnber <br />3 H 1 1 ~ cnLLna Clerx <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAVER NAME AND atAlUNti ADDRESS - <br />Business Name Name <br />Yancey Motor Hotel Grand Island Inc. Yance Motor Hotel Grand Island intr.- <br />- Streai Apdress - - - Street or Otber Ma{nnq Addrois - - <br />2nd & Locust Street _~ _~ P.O. Box 1228 <br />~' City Stale - Zip Cpde Clty State 2tp Coda <br />Grand Island NE 68803 ~ Grand Island, NE 68801 <br />K - This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant Lo-the - _ <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which ate <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes etuLttitute <br />a lien in the county far real and personal property belonging to the taxpayer or horesfteracquired. <br />Tax <br />CatsaoaY <br />I Number <br />lax Peri Data o1 <br />od Assaunent <br />I <br />Amount of Tax ~ <br />Penalty <br />Interert <br />Additituta Balanw of <br />Assgamarn Dua:- <br /> ,02-O1-8 thrul ! i <br />68 '02-28-81 110-2i-8 454.54 14.06 99.20 567.80 <br /> 03-01-81 thru{ i <br />68 103-31-81 110-2T-821 523.31 16.18 108.19 647.68. <br /> 1 04-01-81 thru 1 <br />68 j04-30-81 110-2]-8~ 489.72 15.15 95.42 , 600.29 <br /> 105-01-81 thrut " - <br />68 11:75-31-81 jlp-21-8 <br />-~ <br />- 459.24 <br />- __ <br />-- <br />- 1.4.51 <br />_ <br />-- ~ 86.03 <br />-, _ 569.78 <br /> 106-O1-81 ---1- <br />thru, ii - <br />-- - <br />-- - ;-- <br />68 106-30-81 I10-21-8a 335.58 10.3P, 57.54 403.50 <br /> '07-Oi-81 thruj <br />58 { 07-31-81 ~ 10-21-8~ 351.70 i 10.88 F 56.12 ~ 418.70_ <br /> O8-Q 81 thrui ~ <br />~ <br />68 i 08-31-81 110-21-52~ 363.78 11.25 53.85 i 428,89 <br /> TOTAL ( ~ 3,636.54 <br /> f herapy Car t tnR Nebraska Gapartmm:t nt RYVen~e h mml,o Wfth the rtvMUe IiWf Ot in! State Of N@bY3a%d in th8 U6ter- <br /> mind<Ipn Dt i StIGWn {c ba GayRr ':iriatl CG pay rte a pot nGe atiH/ n@m <br />~ irsO. If tort Notice Df State Ta% <br /> Lien ~a an nsl@n Of a ttftLtiv¢ it ~a tha <br />Gr~nrlty G} tM state's Inler@tt In th0 itf <br />b <br />n Kttd prbpeltY nt the is%piYt <br />. <br />3!911 .~ <br />Revenue ??gent G <br />~11~".~~p ~-- <br />~~~ ,t Sts ~ rleta ~ aare <br /> --'f $DeClal Agent f©-~ ~-~~ <br /> Auihprizetl Signs T Itla Date <br /> 'u FOR COUNTY OFFICIAL`S USE <br />NEBRASKA DEPARTMENT OFREVENUE -~ Whfu and Goldenrod Copies TAXPAVER -Pink Copy COUNTY OFFICE -Canary Capy <br />' a~ig47i Rev, 7-81 <br />Supersepas 4i447a Rw.5~8a <br />+ 1...... <br /> <br />