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nebraska <br />~partmen[ <br />of revenue <br />Notice of Mate `fax ~.ien <br />- • Read instructions un reverse side <br />Lien SerEal Number County Date Soeia! Socuri2y Number <br />9103/180 Nall 3!26/79 505-74-8328 ~9-•~1~i~~~a~ <br />Nebraska I,D. Number Typa Lien Filed Wlth Spouse's $OClai SeCUrity <br /> ~Orlginal RaQister of Deetls Number - <br />3i 0398b [~ Ranewai t_1 eoun.~ ~terk <br />- BUSINESS NAME AND LOCATION ADDttESS ' - TAXPAYER NAME ANO MAILING ADDRESS <br />Business Name Name ~ ~. v <br />The Car et Man __ _ <br />5treeF Address Street or Otner Mailing Atltlress ~ ~~ "~- -'~- <br />3022 West Potash Hi hwa E <br />-------------------- ----------- <br />City - State Zip Cotlp City State up ~ ntle <br />Grand Fs]and, Nebraska 6 01 ~____ _ _ _____ __ _ <br />Pursuant to the =avenue laws of the State of Nebraska, notice is hereby given that taxes (including penalties, intcrea <br />and additions} have been assessed and are due from the above taxpayer and remain unpaid after demand. These taxes <br />constitute a lien upon property in the county belonging to the taxpayer or hereafter acgnirett. Liens for sales and use <br />taxes only attach to the real property of the taxpayer located within the county or hereaftet acquired. <br />Tax <br /> <br />Nuatm~ba <br /> <br />01 <br /> <br />T~Ps~nd <br />i/1/79 thru <br />2!1/79 thru <br />Data of <br />~ <br /> <br /> <br />3 23 79 <br /> <br />4r22aL.!tt of Tex <br /> <br />~, <br />i 399.71 <br /> <br />P,Qpatiy <br /> <br />i t„t.ren <br /> <br /> <br />( t" ~-~- <br /> <br />~ Aei.ini--- <br />---- <br />.-_ <br />t - ~ --~ <br />~ Balance of ~ a <br />Assessment vue <br />----------.___ __, <br />_-~:-246_.83--,--_ <br />1 394.71 <br /> I <br /> <br /> I <br />t 1 <br /> <br />i i <br />i <br /> <br />- TOTAL €$ 3x646.54 _ <br />t nvwy certify that 2ne tVCpralka Dep:Rmen2 of Reyenw nas complretl wun the rerenve laws of the State of Nebraska ~n a deter- <br />' [ntnat}pr1 pf fn! arnOW21 SRpwn t0 be dul. a»d tM taxpayer Rai tailed FO pay SRe dm OUni due dater tlemdnp. (f leis NG2fCe Ci7 State Tax Lien %i <br />= M elriMratOn OL N dffeciiye ifen i# fitlt'ei #p CMfft:nW 2R! WrW sty Ox [nt State's in[!r!i". in ant atfeCtetl prpperty of [ne taxpayer. <br />~- ~Q~~ J~ Special Agent 3 26 79 <br />TAUtttoriaW a TRie Date <br />Fon cotr~ttY oFFtctALa tt>~ <br />NEBHASKJI DEPARTktE1aT OF REYEkUE -1M+aa and Canary Copies TAXPAYER - Prnk Copy Cp{JNTY Cr f;CE - fotdenrod Copy <br />s-aya~.ae,. z-'a <br />suparseon a-6ya-~.; Rev. i1~77 <br /> <br />J <br />