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~~ ~ Notice og State Tax Lien nebraska department of revenue • Read instructions on reverse side - Lien Serial Number county Date Social Security Number ___ 8/12/S95 Lancaster 12/19/78 508-54-6197 77`x' Vll~aw~j Nebraska i. D. Number Lien Type Original Lien Filetl With Register of G¢eds SPPU Social Security Number Renewal ~ Gounty Clerk - --- t BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAP+IE AND MAiL iNG ADDRESS ------- ~-- o F Business Name Name ----~-~---- CIIY State 2iP Code CItY Slate ~-- --~T,P Coda ~~-~ SI~.*'°ca _~ (~lAl T.inmin __-_ A1F'----- 6A5Ad--- Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that fates (including penalties, interest and additions) have been assessed and are due frmn the above ta.cpaycr aad retrain unpaid after demand. These laves constitute a lien upon property in the county belmtging to the [a~payer or hereafter acquired. Liens for sales and use taxes only attach to the real property of the tagtayer located within the counq~ or hereafter acquired. Tex t GteporY Number Dete of lax Period I Amount of Tax ~ ~ Assmsment I ~ ~ Penatry 1 ~ ~ ' Interest I ~ Balance of Additions Ass sment Dun ~ _._ Ol 01~3I/77 '082 8~ 63.23 j 02 0 7 tl~tzu i ------ ~ --- 5.00 ': - --- f _ 12 00 __ ~ _-f-_.. i 80.23 - -~ ~^~ ~-+-+ a.n~o s~o nn; ~ n_T '3d I 03 0 . • ' 5_ nn 14.84 i _ _ 161.1$ O1 X 03 3 7 08/22/78 127,60 ~ ' .. ! 5.00 ~ 12.76 ~ i 145.3b _ - 04/01/77 thni ~ I ~ - -~ - ---- - - _ ___J V __ ~ 5 O1 134.03 0 7 08 8 5.00 12.73 - i - -- L 1.76 - ---- -- 05/01/77 then I I I ~ 06/0'1/77 then 1 5.00 10.5,E ~- j -----~ ]r39.50 07/01./77 thrtx 1 7 8 8 ~ 9.98 I ~ l~g,_7.8 08{01/77 thLU 1 102.5.1 O1 x/31/77 08/78 90.71 5_00 6,80 TOTAL ~5 1.129_83 1 nerebY certify that the Nebraska Departm enl al Revenue has complietl with the revenue laws of fns State of Nebraska in the dettr- minat Pn the amount shown to be tl tl the [a.Payer has failed to p., : t~ a amount tlue atler tlamantl. It this Notice Pf Siate Ta.v Lien tF do ex(CAS - O/ do Cllect~Ve Iltn n Ser vtS COr1(yl u2 lh¢ pri Or~ty Of (h2 $tat!'S in(¢r¢5t in tn¢ of I¢Cf¢tl prPP4rty Gt InC [a+payer. I/j~/~ ~~~ ~r/_i 1"~ ~lfsv,~ld~` Mat]3gBt 12/1..3j78 ~1'~ f ___ _ ___ Ault, riiep igrmture ~ rule Oats FOR COUNTY OFktC1A1'S USE INbIgIr>d ~ ~L twtaaa~-~ _ .. aeNElsAt. Cl 1i1 Rr~ ~: ~~ Nii`i,~ ~I s ~~ FtLEC~F;t .:~~ €;~":~ itE('aNu ., INS7: ~o. ~8- 331.6 NEORASKA DEPARl'MENT OF REVENUE - Wn~ta and Canary COple1 YAxPAV ER - Pmk Lcrpy COUNTY OFFiCf -- Goldenrod Copy 4 ~tua-?a Rav, _~ly Supers.ges 3-a9,t.as Rw.. 1 t -37 • ~ J