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F <br />cflydr53X ~i <br />tle"S 31 iPnY:nf <br />~t <br />i?vp;nue <br />Lten Seria' N"umber IC9x:nty <br />9f77/872 ~ !tall <br />Nebraskd 1-D- Number Type <br /> Ori9inat <br />3354458 t`7 Renewal <br />Y Rasd IflStrUetCrSn6 Mr' Weyeraa Sail<i <br />_,~~ Date ____.-,.~,_ ~ocfa__~,.__~._7~_ Caumbw; M__ ~ _.__-..,..,.,.~._.____"_-___,~^ <br />I ii-74-79 ~ 50$-70-9583 ~7CJ,,,,4 ~~:~~~~ <br />;Lien >=iteG with Spouse's $Utlai Security j <br />{E'~ Re9Kter o1 Deeds~NUmber <br />`i _i Cot:ntY Clerk <br />BUSINESS NAME AND LOCAT1oN ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />Derb Retail Seck.• Autr <br />Street AtlCress Stree: or Othtr Mailing Atl tlress <br />7135 Sot<th Locust Atlas Trailer Court <br />City State Zip Cpoe City Stace Zip Cotle <br />Grand Island Ne, 68801 Wahoo Ne. 58065 <br />Pursuant to the revenue caws of the State of Nebraska, notice is hereby given that taxes,(including penalties, interest <br />and additions] have been assessed and are due from the above taxpayer and remain unpaid after demand. These taxes <br />z constitute a lien upon property in the county belonging to the taxpayer or hereafter acyuired. Liens for sales and use <br />taxes only attach to the real property of the taxpayer located within the county or hereafter acquired. <br />Tax <br />Cate¢mY <br />Numbor <br />Tax Period Date of <br />Assessrrlent <br />Amount o4 Tax ~ ~ <br />I Penalty <br />j ~ <br />i Interest <br />I Additiorss <br />I I Balance of <br />i f <br />Assessment D <br />ue { <br /> ~9-22-78 thru <br />3 Q~_ <br />15 <br />26 - <br />3,45 <br /> <br />---u- 10-1-78 thru <br />- - <br />-8L11~ Z~ <br />--- <br />~ _ <br />1 <br />1 <br /> <br /> <br />---- <br /> <br />- <br />j - <br />--- <br /> , <br />j ? <br /> <br />j <br /> <br /> <br /> <br />TOTAL ~$ 2,,97 <br />1 Hereby certify roar the Nebraska Department of Revenue nos complied with the revenue Taws of the State of Nebraska In the tleterv <br />m lndtlon o/ lne amount shown to be due, ono the taxpayer has tailetl to pay the amount tlue after tlemantl. If Fn15 Nptlee of State Tax Lien ii . <br />an ex[enslpn pf do of}active Iten it Serves t0 Contin Ue the pri OYity Ol the S4ate'S interest in the dfieetetl property pt the taxpayer- <br />Slgn = <br />~~#~~ ~'~`~~~~~- ~peciai Agent >/-i t-?~' <br />.~AUthorized Signs / Tltte Date <br />FQR Gt3UNTY DFFICIRL'S USE <br />- NEBFiRBrCA UEPARTM ENT OF REL'ENUE -While and Canary Copies TAXPAYER -- Pink Copy CUUNTY UFFIC~ -~ Golctnnrod Copy <br />a-a9a7a Rev, 9-74 <br />Suparsetles a-496.74 Rev. 2-78 <br />_. - _ _ -. _ <br /> <br />{.~ <br />