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Form ~~~ j t~;~p~}}~~f~ao€pf S a.~~AlapDO~nDa7~2mertVVOf the TGroaz~upi9-a~fi,'.der6na~ftoYVfeinBUe Ser.•ilceg a~f ~f as i. ~a~~+ CNev.seo:emCert~78i1f1 ~Li~YIyY.~~~~6~.iV;~Q$- ~~A ~~te~i Edl9llFe~ ~Snl7s~~j~i 13~eYQ.etU~i €..&~,tlVa .L__.. Qistrict ~$eriatNumbe: ~~ ~ " ~ j ro, o~t,o„ai use b>> rjacr .c once-- i_~~ _.__~__------ ~~ ~ = 36k66 j gg -~~ As Provided fay sections 627, G322, ar,d &323 0; the lni8rne: Kevenur. Cave, j ~0--- \~~~~ natica is given that faxes tinctud'zng inter^st and penalties; I~:.,v;--~ ueen assessed against the fcilcwing-named taxpayer. Oemartt# for Faymrni of this li::bility has ~ _ basil made, but ii remains. unpaid. Therefare, th&re is a lien ir. favor of the Unifed Slates i3ts ail property and rights to praperiy t+etonging tr. this taxpayer for the ! a~ouni of ttaese saxes, and addltiona! penalties, interest, a :d costs ±haY msy a€rrue- -- _. _~ I Name of Taxpayer .._ . IJale ~. ar3;d Judy A. Mercer j i i Residence lk3xj hest Cagif;al Aw.:tiue Grand Islands Nebraska 68801 lCmd o~ Taz Tax Period Ended ; Date of Assessmersl tai tA3 j rc3 101x0 - ~ 7812 10-15 79 aster cf Deaeds Gall # Is3ax~d, Nebraska 68901 identifying Numbc3r ~ of Assessmanf iJ) (e] Total ' ~ 1, 898.69 T~ia neMCB ws ptgperad a+xl sigrrod ai ISIaY-d~ 9103 -_ _- - 011 this. _ daraf ~ ,ts80 ~~~~~,~ !This Ialre I1. Metsger j Rew~tue Officer flUwr a at Car s<,~r:a+~~M W 3as ra asap aim.,.~me+wn :s a.rF aasantaaf ro tM vaieartY od tiut:ea o/ ;i0w1 Sas taMa G.C.Y. ?bi#6! rail, ;;~. tki,j Pan t - 7o be Icapt by ef!-icQ Farr, 668 (fiev. 5-78}