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~ca~'ice of ,~~~ "T~~ ~..i~en <br />ne,r~tk, <br />artn:enr <br />r, <br />of •rPVenue a Raaad insRru~ct3on~s pin reyer~sa sxde~ <br />L1eD Serial Number jCO UntY .+aflt .~--..~ q[3ml atGU f1. ~' iWUrrlber' ~~ 1 <br />t <br />9J1 i J8i i ; Hai i 1 i -14-T9~ 508-70-9583 ~ ~s~.._, ~'''~'~~;,~."~ ~'^_.____._._.._.__..~ <br />Nebraska I.D. Number Lien Type i Litn Filed Wrth $pOLSe'S $pLial Security <br />~Ori9ina! Register of DeedsiNUmber <br />~3FifldriP. 1 :: Renewal I(i countyclerk I <br />BiISfNESS NAME AND LOCATION ADDRESS TAXPAV ER NAME AND MAILING ADDRESS -~ <br />Business Name Name <br />OerbY Retai 1 Becl:y Autry <br />Streit Address Stretk Or Other F.}aetrng AKCress <br />.1135 South Locust I Atlas Trailer Court <br />cliy State Zip Cotle City State Zip Code <br />brand Island. Pie. 68801__ ~ Wahota. Ne_ 68066 _ <br />Pursuant to the revenue laws 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 saxes <br />constitute a lien upon property in the county belonging to the taxpayer or hereafter acouired. 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 of ~ ~ <br />~ Assessment f Amount of Tax I ~ 1 ~ Balance of <br />Penalty f Interest i Additions Assessmen` Due <br /> <br />O1 -1-78 thru <br />-30-78 i <br />7i21l79~ 16.39 ~ <br />25.00 1.04 ~ 42.43 <br /> 10-1-78 thru <br />- ms- <br />~1/79F 35 78 ~ i <br />25.00 r_ 2.16 ~ ! 62.94 <br /> i <br />i <br />~ <br /> i i ~ <br />~ i i <br /> ~ i <br />I <br /> <br /> <br />TOTAL i S 1 fly 37 <br />I hereby certify that the Nebraska Department of Revenue has compiled with the •revenua laws of the State pf Nebraska cn Ina deter- <br />mination pt the amount shown to be due, artd the taxpayer has failed to pay the amount due after demand. It this Noti<e of 51ate Tax Lien is <br />an extension of an effective lien it serves to continue the Rriority of the State's interest in the affected property of the taxpayer/.~ / fj <br />Authorized-Sig re-- Title - F:afe <br />- '~ - - - - FOR COUNTY OFFiC1ACS USE - - <br />NEBRASKA DEPARTMENT OF REVENUE -- White and Can;rry Copies TAXPAYER -- Pink Copy COUNTY OFFICE - Golfienrod Copy <br />q-a9a-7a Rev. 9-76 <br />- - Supersedes 4•aga-7II Rev 2~7a <br />c - - <br /> <br />1~ <br />