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i~ <br />r i <br /> <br /> <br /> <br /> ian <br />f ~~ate ~`ax ~ <br />ti <br />RO <br /> ~_ . <br />ce o <br />o <br /> nebraska <br />department <br />- <br /> <br />o'revenue • Read imtruetipns on reverse aids <br /> Lfen Serial Number County Date Social Security Number <br />7g- <br />R <br />9/02/125 <br />Yiall <br />~' ~ ~ ~- ~4 <br />2-28-74 507-3b-4001 <br /> Nebraska I.D. Number lien Type Lien F{letl With Spouse's Social S: curity <br /> Orfgi nal ~ Register Of Deeos Number <br /> Renewal ~ County Clerk <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />f; Business Name Name <br />G <br />P. 0. Box lbb5 3830 Garland <br />City State Zip Code City State ZID Cotle <br />Grand Island NE b8801 Wftea Rid GO 80033 <br />Pursuant to the revenue Paws of the State of Nebraska, notice is hereby given that taxes) including penalties, interest <br />4 - <br />and additions) have been assessed and are due from the above taxpayer and remain unpaid after demand. These taxes <br />F constitute a lien upon property in the county belonging to the taxpayer or hereafter acquired- Liens far sales and use <br />i tares only attach to the real property of the taxpayer located within the county or hereafter acquued. <br />Tax <br />Cate9arY <br />Number <br />Tax Period Date of <br />Assessrnettt <br />Amount of lax <br />Penalty <br />Interest <br />Additiafts l3atanae of <br />Ass~smant Due <br /> <br />2I t rU <br />Ob/30/77 <br />1/31/78 <br />241.40 I <br />95.55 <br />24.14 <br />I <br />3b1.04 <br /> <br />21 07 01177 thru <br />09130/77 <br />1/31/781 <br />1 Oll.b6 <br />50.58 <br />$5.9 <br />1 148.23 _ <br /> <br />21 X 10/01/77 thru <br />12/31/77 ( <br />9/27/78 <br />380.33 ~ <br />19.C2 i <br />26. b0 ' <br />42:s,~5 <br /> I <br /> <br />_- ' <br /> I <br />TOTpL ~S 1,935.27 <br />{ hereby certify that [ne Nebraska Department Dt Revenue has <om ptietl with the revenue laws Of tht State of Nebrasxa in [he tleter- <br />minatiOn pf the amount Shown io be tlue, and rite tax Dayer has failed t0 Day the amount tlue alter tlemantl. IL this Notice of State Tax Lien i5 <br />an extension o1 an effective lien it Serves to Continue the Or~Ority of the S'ate's in[ere5t in the affected PrODerty of the taxpayer: <br />~II~~ Special Agent 3/2/74 <br />~r~- Aut Ftpr4zetl Si9~tur Tile Uata <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE -White and Canary Copies TAXPAYER -Pink Copy COUNTY OFFICE - Ga{tlenrod Copy <br />4.494-74 Rev- 9-76 <br />Supersedes 4•a94-74 RBV. 2-76 <br />_ .. - <br />µ _ <br />E <br />