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Notice of State Tax Lien <br />nebraska <br />~~partemen; <br />!! • Resd instructions on reverse side <br />Lien Serial Number County Date Social Security Number _ <br />~/Ol/OfF Hail i-Z7-SO ~-~ VLL~oFr/fQ <br />Nebraska I.R. Numbef n Type <br />~i Original Lien Filetl With <br />~,i Register of Deetls $PDUSe'S Social Security <br />Number <br />~~tt ppi~tt <br />35~V60V ~ Renewal ~` County Clerk <br />I esvsswts~ NwMe AND LtX;ATiON ADDRESS ~ TAXPAYER NAME AND HARING ADDRESS <br />suslneu Name. I Name , <br />City Sta;e Zip Cone I City <br />1'tfrsusnt #o the retr`ettue latys of the State of Nehrasl:a, notice is hereby gieen that taxes (including penalties, interest <br />and additions) have Dees assessed and are due frortt tits above taxpayer attd retnain unpaid sfter dematxl. These tares <br />caasYitute a lien upon propert}• in the county belonging to the taxpayer or hereafter acquved. Liens for sales and use <br />taxes only attach to the :rsl gropaty of the taxpayer located a~thin the rnunn' of hereafter xgttired. <br />Tax <br />Th <br />Tax Faried ~ <br />A1r <br />Atnotxtt of Tax <br />Penalty <br />~ Interen <br />Attditibl¢ Babrin of I <br />Assessment Due <br /> <br />~~ 4-i-79 thru <br />_ _ i <br />f <br />i <br /> 7-i-79 thru <br />0 ~ <br /> ~ ; 1 <br /> <br /> <br /> <br /> ; <br />TOTAL ~$ 36U~,3 <br />~ Nsrmy a:er;iiy tirM tnC Nebraska Deiattmmt Pt Reventx has camp;ietl r11H the reWhua laws of the State of Nlbraua .n ih! Wtar- <br />mSGatiM pt Ih! amQrrnt snmrn tP 3re hue, al)d tM taapayer WEf faiteO tP Day ;h6 amOUn[ tfue alter tlemand, { t Iniz NPilc! 6' Sidi! Tdx L,ian 1a <br />an eX ltnapbn pt an ltSel.Yrue linh i3 verges t0 :6rl/inu! YM pfionty al the $ta1!'s tntereSE in the itiettep ¢roperty PL in! td+tulyex- <br />astttaprx:s Sia rt;e S t a 7 {~{uf t 7. i 7.R1] <br />Date <br />