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netrraska <br />department <br />of revenue <br />Notice of State Tax Lien <br />eflead irratruMibtts on reverse side <br />Uen SNiai Number Lien Type Oate Social Security Number <br /> <br />0/02/186 `~ Original <br />2/12/80 <br />508-54-4668 <br />~i~~1°~~~ <br />~Q- <br /> ~I Ranewai -• <br />Nebraska I.D. No. County Llen Flied With <br />~ Spouee§ Social Se[ur{ty <br />Number <br />75263143 Hd11 Rayister or Deeds <br />County Clerk 506-50-8885 <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />eus~ness Name Name <br />Terry R and ltldy A Jaktt?;o~vski <br />Street Atldresi IStraei or Othet M1^~ Ilitg AtldraSs <br />~ anz Cniit~ Tt attcc~n <br />City State Zia Cotle Ci[Y State Zip Cotle <br />i Grand I land Ne 6 ~Ol <br />Pursuant to the revenue laws of the State of Nebraska, notim is hereby given that taxes (including penalties, interest <br />slid additions) have been assessed and ate due from the aiwve taxpayer aI:J remain unpaid after demand. These taxes <br />constitute a lien upon property belonging to the taxpayer, or hereafter acquired by the taxpayer, and located in the <br />shave count}•. Lieas fae sales and use taxes only attach to the real property belonging to the taxpayer, or hereafter <br />acqu~ed by the taxpsyer, and located in the above counn . <br />Tax Date of <br />Category Tax Pstiod ~ Assessment ~ Amount of Tax ; Penalty interest ~ Atlditioiss ~ Assessment Due <br />1 Number ~ <br />~1-1-78 thru <br />22 ~ 72-31-;'$ '4!15!73 ~ 153.00 8.35 "0.12 ~ i 179 27 <br />~ I <br />Y <br />,-- <br /> a <br /> ---------___ <br /> i <br /> i <br /> TaTa~ ~ 170 27 <br /> ! nttK+Y ci IMI int iJCtxd a DORai:sn a, r Ravtnst n ~. tfia >!ata J4 <br />i <br />~ <br />~ <br />' <br />~~ Nei!e arks rR a tlttar- <br /> niIran ~ `fit 2 4nt - G ht <br />T Jut, dnd ila <br />dn Rd Yei n dviep L <br />Jay <br />t_t <br />d <br />1 ' t <br />L <br />~ ^:S \ ~' Stdt2 'da <br />• <br /> i~ e5 do 8x:e1~5_ <br />iteCtLVa I~e n ~t 58rvef i] .an.~n ue _nt .i Rr~tl vi'^.t Stall S <br />: <br />n,2r a5. ~ t t s 3c,e,: Jr_ ~a"~' <br />.LL .1e .3*Ri Ytr. <br /> A <br /> <br />~~~ r <br />''~ <br />Revenue Aaen <br />^ : l ~; !? <br />~~ <br /> <br />Preaxer S <br />~ t ~ <br />T~taa <br />7 - <br />Hate <br /> . I <br />~ ~._ <br />,. <br />~ + <br />5oacia: ,keen. <br />2/12/80 <br /> AutnNl2e1 2ptaT4Te _~ <br />T,t to i . <br />FOR COUNTY OFF:CIAa_'S USE <br />NEBRASKA DEts.AfiTMENT i)F AEVENLlE ~ Wn ~_~anc Canety Cen;as TAx.PAyEA-P.n.. Cvpy <br />COUtJTY L~Fr ICG - Galoenrca %opy <br />--3y1-;3 Rz.. ..-%~ <br />i~,.e~>anes -,93 :a Aar.., '9 <br />~" J <br />