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~~#i~~ ~f ~tata Tax L6en nrhraska department • Read instructions on reverse side Lien Se+ial Number County Date 79 Social Se<uritY Number 3 a~~`~ ~~-- ~)`~ 9/03jI.40 Hall 317/ . . Nebraska I.O. Number Lfen Type Llen Filetl Witn Spouse's Social Security 1457322 Ori9i nal Register of Deetls NumpE: L.J Renewal V County Clerk I BUSINESS NAME AND LtH:wiwrv wvuwta~ ~^^•^•~••^^--•------°---~-------------- Business Name ~ Name _ _ City State Zip Cotle ~ City 30 Pursuant to the revenue laws of the State of Nebraska, notice is hereby a ven that taxes (includ"mg penalties, interest and additions) have been assessed and aze due from the above taxpayer and remain unpaid after demand. These [axes cansiitute a lien upon property in the county belonging to the taxpayer or hereafter acquired. Liens for sales and use Taxes only attach to the real property of the taxpayer located within the county or hereafter acquired. Tax CateOorY Number lax Pertod Date of Assessment Amount of Tax I I Penaltq Interest - ~ Addkiorts Balance of A~~r~nt pga _ ll/O1f78 thru I 858 60 ___p~__~ "- , 12/Olf 78 tlzru ( ___, ~ i7s T~~~-_, ~ - _ ^,~?t,~~ ~ _ - - ~ 1 i ~ -~ I I _-. _^__ TOTAL ~+s ar rv.s.-~. I hereby certify ?ha? the Nebraska Department of Revenue haz tom Rtietl with the revenue laws of the State Ot Nebraska in the tleter- inatiOn of the amount shown to be Cue, anC the taxpayer nas failetl to Pay the amount Cue after tlemaPerty of fthe ~axpaye5tate TaX Lien is an Ex tension of an effective lien it Se+n'eS 10 COntin~E the GriOr~ly pf the State's interest in the d1fe CCeC pro sign ~ __~ s~ia1. ~e~t 3/~.zI79 ~~;~~uthc+~retl Si ~ t Ttle Date ~- FOR COUNTY OFFICIAL'S USE NEBRASKA DEPART0.IENT OF REVENUE -White and Canary Copies TAXPAYER -Pink Copy COUNTY OFFICE -Goldenrod Copy 4.344-74 REV. 9-Ta Supersetles 4-494-74 Rev. 2-Ta t