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i INSTRUCTII~NS PURPOSE OF FORM. This form is to be used by the Nebraska Department of Revenue for the purpose of notifying the appropriate county authorities that a Notice of State Tax Lien is being filed against the taxpayer indicated on this form. The tax category number cna~s and the Nebraska tax programs they -- - - represent are listed below. OI .. ` .... .......................Sales Tax 02 . . . .. . . . ................Retailers Use Tax 04 ...... ................ Consumers Use Tax 10 ...... ......................Part-mutuel 21 ...... .............Income Tax Withholding 22 ...... ..............Individual [ncome Tax 23 ...... ...............Fiduciary Income Tax 24 ...... .....Corporate Income and Franchise Tax 36 . ..... .............Documentary Stamp Tax 44 ...... ...... Mechanical Amusement Device Tax 45 ...... ....................Severance Tax 46 ...... ...................... Estate Tax 47 ....... ....................Cigarette Tax fi7 ...... .......................Litter Eee fib ...... .....................Lodging Tax 71 ...... .......Interstate Motor Carriers Fuel Tax 81 ...... .....Motor Vehicle Fuels Importing Dealer 85 ...... ....................Aircraft Fuels 91 ...... .....................Special Fuels ~ 9 R ~ 3Lf~ a ` ~ cn o ~ !~ y ~ ~' ~m r, •~\\ ~1 ~~` ~ ~-~ N ~ -: "1 ~ ~ i~ \ ~ ~ ~ - W - _ ( = ~ W ~ . r .o ~ I rD CL1 ~- N K J ` ~ Z C~ 'r~` ` ~~~ O `., ~ . \ C \. u ..,., l_ J