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~_ department79-~uu191~ ~otie~ ~f State Tax Laen of revenue • Read inmuctions pn reveres sine Lien Serial Number County Date ~~ ~5 c~al~Sec~u~i~t~y Number $/03/193 Hall 3-28-79 51 08-48.-1810 Nebraska 1,0. Number L~ryen Type Original en Filed With ~ Re i f D t Spouse's Social SeCUritY 21-2478714 L g er o s eetls Numbar U Renewal C County Clerk Name BOA BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAU wr, cnnaccc , ttusmtss rvam< Blue Ribb - Street tltlreSS 3231 Ra rt y made Plaza 2306 West Feralta State Zlp Cooe City State land NE 68801 Mesa AZ 21p COtle 85202 Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that taxes (including penalties, interest and additions) have been assessed and are due from the above taxpayer and remain unpaid after demand. These taxes constitute a lien upon property in [he county belonging to the taxpayer ar hereafter acquired. Liens for sales and use taxes only attach to the real property of the taxpayer located within the county or hereafter acquired. Tsz CitWOry Numbs Tax P~riad pna of AtsrKSrttaft[ Amount of Tax Penalty Interest Additiotts L3alarlos of Aseeasmant Dta 1 Z1 4/1/76 thru 6 3fl ?6 7J1J76 thru 7 31 7b 3 29 78 3 29 78 638.50 44.20 31.93 2.21 102.08 6.38 772,51 52.79 __ _ Torat, tS 825 30 ! htr<by Crtify that the Nebraska Department Ot Revenue nas complietl with the revenue laws Ot the State 01 Nebraska In Fne deter- Tninaitpn Df th< dmpUnt cnbwn to be Cue, dnd the taxpayer nds }alley LO paY [he am OUnt tlU< alter tlemdntl. It LtliS Nptice O! State Tdz Lsen ii an 2€t<ris.On 4t an e{t<ctrYt iitn ~t KrvCE tp COrtlin Ue the pri Of~ty O{ fhe $tata's interest m She diftttatl ptOperty p{ the Lexpdy<r. ~ Spec3.a1 Agent 3j29/79 ~~ Autnorized Stg Tit1G Data crm rrv wrv scar. a. •~ ..cc NEBRASKA DEPARTMENT OF REVENUE -White arW Canary Copies TAXPAYER -Pink Copy COUNTY OFFICE - Go4ttenrod Copy -- - - - 4-A9474 Rev. 9-7a - - ~ - -- Supersedes 4-49474 Rev. 2-78 ~..' .~z~....~ ..-_ _ ~ L