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nebraska <br />tfepartmem <br />of rwv <br />N®tice of State Tax Lsen <br />• Read instructions on reverse side <br />Lfan Sa(fal Number County Data Social Security Number <br />4/d-G~698 Hall 10-9-79 %~~r+~]{~~~6`~~ <br />Nebraska t. D. NUr:Sber ?ype le~.W(th <br />f.i $p0:t5e'S Sptial $eturity <br /> ~Q(191na1 Ra9ister o` `Deeds Numoar <br />9 t, <br />3~3V734 ~ Renewal ~ Courtly Clerk <br />BUSINESS NAME AND LOCA7IQN ADDRESS ~ TAXPAYER NAME AND MAILING ADDRESS <br />#3usiness Mama Name <br />State <br />Zip COda ~ CiiY <br />Patsoant to the revenue laws of tare State of Nebraska, notice is hereby Given that taxes (including penalties, interest <br />Gard adtlitix:ns) have been assessed acrd a.,e due from the above taxpayer and remain unpaid after demand. These taxes <br />consiituh a lien neon property belonging to the taxpayer, or hereafter acquired by the taxpayer, acrd located in the <br />above county- Liens for sales and nse tat;es only attach to the real property belonging to the taxpayer, or hereafter <br />acquired by the taxpayer, and located in the above csttnh-. <br />7a: <br />ttilfr <br />' Ta: Pargd Dan ~ <br />~ ~ ~ Amount of Tax Penalty interest <br />Additions ~~~ ~ <br />Assatsmant Drat <br /> :t-1-79 throtto <br />7..~ ~ z a, <br /> <br />i I <br />~ <br />I ~ -- <br />- -+ <br />- 1 <br /> t <br />i ~ 1 <br /> i f <br />~ ~ ____ <br /> I ~ ' i <br /> i <br />a ~ ~ ( ~ 1 <br />zG7At ~ g 73.08 <br />1 Aq'airy L~ttify inat the NeD(3iKa D6Mltman2 of Aevenua nos cOmpiiad wAtn Ina teVanUi tdw5 of tfie State Af NaD(ailu is tne QataT- <br />at ttu amount shown to be ax, ana me taxpaYSr nos Yelled to pay tna amp:ini Gut after oamano. I2 In7s Natip~ of Slate Tax Lion is <br />an oxtansion a1 an ttficttve :bn 12 serves to Lan2int~a tna Driwity of Ihf $taIiY IMarist in tna affected prppittY at tni taxpaya*. <br />~~ ~ nx}et:ial keettt 10-4-T+~ <br />~. RatnmtLad ta! Title Date <br />r FtJA C09JNTY DfflltiAL'S USE <br />tKE9RA59GA DEPARTl9ENT t"3F REVEhI£ - Wnre a+d GesvY Cxrm TAXP,4Y ER - Pr.:x t=oc?~ COUNTY OFPlC<- Goldenrod t.apy <br />a<9m-Ta Rw. 5-Jg <br />Supuseaas a-age-Ta Rev. 9.79 <br /> <br /> <br /> <br /> <br />