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N®tice ®f State Tax Lien.: <br />nebraska <br />department <br />n( revo-m,a • Read instructions on reverse aide <br />Li¢n Serial Num~ COUnty Date <br />1 <br />3 <br />79 Social Security Number <br />50$54 <br />4668 <br />7g~ i) ~ t ~ ~~ 1 <br />9j43/i3#} :fall /0 <br />J •- <br />Nebraska I.C. Number Lien Type Lien Filetl With $p OU$e'S Sp<ial Security <br /> ~ Original ~ Reg'st er of Deeps Number <br />~}r <br />211E (J426 ~ Renewal ~ County Clerk <br />! tirJJiNE5ti NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />~T y R. Jakubowski. R. Jalcubot+~i~.i. <br />Street Atltlress Street or Other Mailing Atltlress <br />903 South Clausen _ 903 Saith Clatssserr <br />City , Slate Zip Cotle Cit; State Zip Cotle <br />-r*-aaY+ Ts].a*~ Tti~ e8801 I C~and zsls-tnd NE 68801 <br />Pursuant to the revenue laws of the State of Paebrask~, notice is hereby given that taxes (including penalties, interest <br />and additions) have been assessed and are due from the above taxpayer and remain unpaid after demand. These taxes <br />constitute a lien upon property in the county belonging to the taxpayer or hereafter acyuired. Liens for sales and ase <br />taxes only attach to the rea! property of the taxpayer located within the county or hereafter acquired. <br />Tax <br />Category <br />Number <br />Tax Period Date of <br />Assmsment <br />Amount of Tax <br />Penalty <br />Interest <br />i <br />Additiarts Batartee of <br />Asseummt Due <br /> <br />~1 lol0l>>8 <br />~ ],2f31/'78 <br />1 31 9 <br />424.89 <br />21.24 <br />4.25 <br />450.38 <br /> I <br /> i <br /> <br /> 1 <br />~~_ ~ I ~ I ---- <br />TOTAL ~S 450.38 <br />1 hefEby c reify that ihE N¢pra3ka Depdrtm Ent pt REVEnue has cpmpli¢6 with the reversUe laws O* the State of Nebraska in tree oeter- <br />minatron o! the amount Shown to be tlue, an6 the taxpayer has failetl to pay the amourt: tlue after tlemantl. !f this Notice of State TaX Lien 'r5 <br />an eXteRSIUn Ot an ¢lf¢Ctly¢ lien ii SeryeS ip continue the priority of fhe $Sd L¢'i int¢re5i In the aifectetl prpD¢rty Of the td%¢dyef. <br />S1g8 _-- <br />@~,@• 9n~p ~-,;~~ 3peoial ~~ent 03/45J79 <br />AuIh Orl2etl 51 Title Dd[e <br />FOR CQUNTY OFFICIAL'S USE -~ <br />NE6RASKA DEPARTMENT OF REVENUE -White and Canary Copies TAXPAYER -Pink Copy COUNTY OFFICE - Gotdearod Copy <br />a-a9a-74 Rev. 9-78 <br />Supersetles 4-494-74 Rev. 2-78 <br />o # <br /> <br />