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___ <br />INSTRUCTIONS <br />PURPOSE OF FORM. This form is to be used by the Nebraska <br />Department of Revenue for the purpose of notifying the appropriate <br />county authorities that a Notice of Slate Tax Lien is being filed <br />against the taxpayer indicated on this form. <br />(~ The-lax caugory member codes and the Nebraska tax programs they <br />represent aze listed below. <br />01 ..............................Sales Tax <br />02 ........................Retailers Use Tax <br />04 .............. . ....... Consumers Use Tax <br />]0 ................ . . . .........Pori-mutuel <br />21 ...................Income Tax Withholding <br />22 ....................Individual Income Tax <br />'- 23 .....................Fiduciary Income Tax <br />24 ...........Corporate Income and Franchise-Tax <br />3b ...... . ............Docnmentary.Stamp Tax <br />44 ............ Mechanical Amusement Device Tax _ <br />45 :.........................Severance Tax <br />46 ............................ Estate Tax <br />47 ...........................Cigazette Tax <br />67 ........................:....Litter Fee <br />68 ...........................Lodging Tax <br />71 .............Interstate Motor Carriers Fuel Tax <br />81 ...........Motor Vehicle Fuels Lmporting Dealer <br />85 ..........................Aircraft Fuels <br />91 ...........................Special Fuels <br />°Q ~ ~ ~ <br />~ ~ <br />c, m` <br />~ ,r <br />~ t. m ~ "~ <br />,~ m n ~ ^' N c.. <br />~ ~n ~ ~ ~ <br />~ G) T <br />~ 2C1~ _... t~ <br />(~ ~ ~ ~ ~ <br />W ~ Cy 'n ~ = r ~' ~'' ~ g o Cf7 ~ <br />C~ n C ~ ~ <br />~' ca ~ ~' In <br />tt ._.. ~` .~, <br />~ N ' ~ Q <br />f ~- <br />-~,l <br />~~ :1 <br />- -. \G'. <br />