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~; <br />~~ ; <br />_ ~rrabras!:a <br />department <br />of revenue <br />- BUSINESS NRME AND LOCATION ADBRE5S TAXPAYER NAME AND MA141NG ADDRESS <br />Business Name Name <br />Phillips Distributing Co. C. A. Philli s <br />- Street ~Atltlress - Stree[ or Other Mai ling Atltlress <br />523 East Fourth Street 523 East Fourth Street <br />_ City State Zip Cctle City State <br />Grand Island NE 58801 i Grand Island NF. i <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that taxes (including penalties, interest <br />ar.3 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 acquired. Liens for sales and use <br />taxes onty attach to the real property of the taxpayer located within the county or hereafter acquired. <br />Notre of Mate Tax L'aen <br />• Read instructiafss at reverse side <br />Lien-Seriaf Numbe: County Uate Sociaf Security Nu mbar I ('~ <br />7J~"' <br /> <br />9/03/14$ <br />Ha11 <br />3/9/? <br />50$-48-0401.. UU.~7V~ <br />Nebraska i.D, Number Lin Type <br />c~ Orl9inal ~¢n Fifetl With <br />R¢glster of Oeads Spou'_-u_'z Spcial Security <br />Number <br />3059650 ^ Renewal ^ County Clerk <br />i <br />Zip Cotle <br /> <br />Tax <br />Category <br />Number <br /> <br />Tax Period <br />Date of <br />Assessmert <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />interest <br /> <br />Additions Balance of <br />Asse~ment Due <br /> <br />O1 t r13 <br />05/31/78 <br />2/15/78 <br />25.Ofl <br />25.00 <br />1.13 <br />51.13 <br /> 1 thru <br />OI Ob/30/78 2/15/78 25.00 25.00 1.00 51.00 <br /> <br />O1 07/01/78 thru <br />07/31/78 ~ <br />~.2/i5/78~ I <br />25.00 ! <br />25.00 i <br />.F3$ <br />50.88 <br />OI i 08/31j~1'su 2115178 25.00 X 25.00 ( .75 50.75 <br /> 09 01/78 thru <br />O1 ~ 04130t78 2/1578 25.00 -25.00 .63 50.63 <br /> 10/OI/78 thru <br />~ <br />Ol 10 31 78 2 15 78 Z5.00 .50 25.50 <br /> f <br />TOTAL ~S 274.$4 <br />i Hereby certify tnat the Nebraska Department of R¢vertue ha3 com ptietl with the revenue ~aWS of the State of Nabiaska in the Deter- <br />mination of the amount shown [o be tlue. antl tna taxpayer Has faifetl to pay tn¢ amount Due after tlemanD. If tnts Notice of State Tax Lien is <br />an extension of an effective lien It Serves ip fontlnue;he priprity Ot the Stdt¢'s interest in the affectetl prpperty of the td%Payer. <br />Sign special Aeent 03/13/79 <br />~$~~ Authorizetl Si4na Tif t¢ Date <br />FOR CGUNTY OFFICIALS USE _ <br />