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~ebraska departmrrt Na#ace of ~#ate Ta~c Lien . Read irrstructiarc on reverse std. Lien Serial Number ~ County Date ~~~i t ~ ,-, $o^-lei Secu: sty Numbe. ~ ~ V j ~ 04 206 I~il 4 6 9 i1 Nebraska t.0. Number Lien Type Llen Fi1etl With $DOUSe•s $Otial Security I (~.COriginal [7~Re9ister of Deetls Number + 5 21-228265 ~iJ Renewal ~ County Clerk I BUSINESS NAME AND LOCATION ADDRESS TAXPAV ER NAME AND MAILING 4ODRESS Business Name Name C~dnd Island Idrit3l Carer Inc. GYa.*td Island Iawn Carer Inc. Street Ad6ress Street or Other aaaitin9 Atldress 2226 South Blaine ~ 2226 South Blaine _ City State Zip Cotle City Siaie ZiP Code Gland Tnlanei, NE 688fli Grand Island I1E 68801 Pursuaztt to the revenue laws of the State of Nebraska, notice is hereby given that taxes (including genalties, interest and additions) have been assessed and are due from the above taxpayer and remain unpaid after demand. -these takes constitute a lien upon property in the county belonging to the taxpayer or hereafter acquired. Liens for sales and use taxes only attach to the red! property of the taxpayer located within the county or hereafter acquin.d. Tax Category NI umber Tax Period Date of Aasessfnettt Amount of Tax Penalty Interest Additioro _-_ Balarsee of Assessment Due i 1 _ 4/1/78 tl~ru Q 7,/l f 78 Ih>:u 10/1/78 545.68 TOTAL ~S fi~~ 58 1 hereby teriify that [he Nebraska Daparintent Of Revenue has complied with Me revenue taws of the State pf Nebraska in the deter- mination of tn@ amount shown to be due, and the taxpayer has failed t0 Pay the am OUOF tlue after demand. a tMS Notice Ot State Tdx Llen i5 ..- an extension of an effective lien It ser'yes to tpntin Ue the priority Of (he State's Interest in the affected property at the td Xpdyer. _ ~~ _ 5 t 4~n9 ~~ Autharizetl Si9na - e -- - - Trt le Date ,- FOR COUNTY OFFICIAL'S USE __-_ --. TAXPAYER -Pink Capy COUNTY OFFICE -Goldenrod CapY a-49J-7a Rev. 9.78 Supersedes a-a9a-7a Rev. 2-78 ,.....i