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Notice of State Tax Lien <br />nehr dska <br />department • Read instructions on reverse side <br />~.¢ <br /> <br />Llen Serial Number County Date So<ial Security Number <br />9J05/309 Hall 5/25/79 484-52-5490 <br /> <br />Nebraska I.D. Number <br />Lien Type <br />Original <br />Lien Filed With <br />~{Registlr of DledS <br />Spouse's SoUal Sec urlty <br />Number 7~~ /~ `^n' ~y ~+.r <br />t p V { / ~ 2 <br />vV LLJJ I <br /> L) Renewal ~ CountY Clark <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING, ADDRESS -~~ <br />BUSine55 Name I NH me <br />Arlen Ix311L's <br />Street Atltlre55 Street or Other Mailing Atlpress <br />GrtO LL.c4, LL..~.~ir. CJ..-....1. <br />City State Zip Cope City State Zip Cotle <br />Rio tx c~; tY7 TA 51103 <br />Pursuant to the revenue !aws of the State of Nebraska, notice is hereby given that 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 />constitute a lien upon property in the county belonging to the taxpayer or hereafter acquired. Liens for sales and use <br />` taxes only attach to the real property of the taxpayer located within the county or hereafter acquired. <br />Tax <br />Category <br />Number <br />Tax Period Date pf <br />~~~~ <br />Amount of Tax <br />Penelw <br />lnttirest <br />Additiora Balance of <br />Assssrnent Due <br /> Ol/Ol/76 tttru <br />12 6 <br />6 09 7 <br />29.00 <br />~ 1.45 <br />3.70 <br />34.15 <br /> <br />a2 O1/O1f77 thnt <br />vas m <br />i 4 i~nnu <br />txl <br />q ~s <br />~ m <br />i n ~~ <br /> <br /> <br /> <br /> <br /> I <br />__ _-_ __ TOTAL ~S 44.42 <br />1 hereby c¢=ti1y thwt Ih¢ Nebraska Denar;m»< ,.e R_:^':::c ~ ' '--- - ~ . nue :awz of the State of Nebraska in the peteY- <br />na[iOn of tn¢ a t Shown to be pue, dnp the taxpayer hds fdlletl to pay the dmpunt rtlut a!te~ tlemantl. I• in,t Npttce of State Tdx Lien is <br />an lxterl5ipn pt ann Cft¢ct~ve lien it 5¢rve5 '.G cOntm~! Lh< prror'ty of Ih! $tdt!'3 mtere5t !r: the a!+¢cteC prOper!y Of t !'dxpdyei. <br />sign ,~ _ <br />~~f6 44~r (=~~~~a .~~;1Q(`ial Ar~es~t ~`1J-31/9 <br />Authorr~etl Sig a rit le Date <br />Nf$RASKA QEPAR7M EIVT OF RE V'etiUE -- Sth,te and Canary Copres TAXPAYER - P:nk Copy COUNTY OFFICE -Golden od Copy <br />6~39a~?a Rev. 378 <br />$upersebes a~49d~]4 Rev 2-79 <br /> <br /> <br />