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ebraska <br />department <br />~iotice ®f Mate Tax Lien <br />s Read instructions on reverse side <br />Lien 52::x1 Numbs' County Date Social Security Number <br />9143/134 Hall 13/2/79 507-3b-4001 ~~~ ~~#~},~ ~~ <br />ka C.D. Number <br />N <br />bra <br />e <br />s lien Type Li n Fned With Spat;Se'z SOCidi Security <br />~ <br />5 <br />~f <br />~ <br />~67345rj9 <br />i <br />L ~j Original ~ Register of Deetls Number <br />- <br />o- ( j P.anewal ~ County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name J.~ B ~Hy~ aTld ASEiOClat2.4r 111~i• <br />Ar77L7 Y`L~1 QY1't Name <br />,~, <br />treat Address Stree[ or Other Mailing Ad dress <br />Eox 1565 6911 Tn~st 25th Averttbe <br />City State Zip COtle City State Zip Cotle <br />[zrand Island. NE 68801 _ CO 80215 <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby given thaF 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 />cunstihtte a lien upon property in the county belonging to the taxpayer or hereafter acquired. Liens for sates and use <br />taxes only attach to [he real property of the taxpayer located within the county or hereafter acqutred. <br />r Tax ~ <br />Category I <br />Tax Period Data of <br />Assessrrletrt <br />Amount of Tax -~ i I <br />Pe airy Ingest ~ Additions i Balance of i <br />Assessment Due l <br />Nu tier <br /> <br />21 <br />, o4/a1177 ~ <br />____Q6 30 7 I <br />4 24 ~ <br />888.42 ~ <br />197.54 105.48 i <br />1 191.44 <br />___ <br />_ <br />~- l a7/ol/77 tn~u F ~ <br />1~ ~ 0~~15/77 <br />' <br />, 1 <br />- <br />-~ <br />1 -~ <br />- 1 ~ ~ <br />1 <br />-- T <br />- <br />_~__ <br />~ <br />f i <br />i ~ <br />_____ <br />s <br />i i <br />I <br />- F- <br />It 1r OY~•VG <br />TOTAL ,~ <br />I hereby certify that the Nebraska Department of Revenue nas complied wi(h ins revenue laws pf the State of Nebraska m the tleter- <br />inaticn of the amount shown to be due, an0 the taxpayer nas failed to pay the am punt Cue after demand. !f this Notice of State Tax Lien i5 <br />an extension of an cited rve lien is serves to continue :ne pn prily o! the State's in,ere5t ir. the affected property o` ins taxpayer. <br />$Ig~ _ Special ~t 3/7/79 <br />~~~~ Author+zeA S+ tore Title Date <br />~~ ~ FOR CQUNTY OFFICIAL'S USE __J <br />NEBRASKA DEPARTMENT OF REVENUE -White attd Canary Copes - TAXPAYER -Pink Copy COUNTY OFFICE -Goldenrod Copy <br />II-494-74 Rev. 478 <br />Supersedes 4494-74 Rev. 2-78 <br /> <br /> <br />J <br />