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. Form ~~$ -{ } /r n{ q Drepairtmentyof thle Tpreas~wty-ptntemaa.t Rev„e}naue aS~ervice~jp pa~iF ! W <br />(Rev. September 1978) {~~+~V~-Yi ~~U~7"i~l ~~A L~Vif ~4i~~3 ~, 114~:1~~ /1{-i~itii'i1~ 6~71t~ <br />' District Serial Number , FOr Optional Use qy ReGOrdinp OtRCe <br />r t~fA.HA 47 ~ 36556 <br />As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code, <br />notice is given that taxes (including interest and penalties) have been assessed <br />against the following-named taxpayer. Demand for payment of this liability has <br />been made, but it remains unpaid. Therefore, there is a lien in favor of the United <br />States on all property and rights to property belonging to this taxpayer for the <br />amount of these taxes, and additional penalties, interest, and costs 4hat may <br />' accrue. <br />Name of Taxpayer <br />Mrs. Jans Day Care Incorporated (A Corporation) <br />415 West 8th Street <br />Grand Islandr Nebraska 68801 <br />- ' T ; <br />Kind of Tax ! Tax Period Ended '; Date of Assessment ~ Identifying Number <br />(e) - + (b) 1 (W ~ fd7 <br />941 - 1 - <br />i <br />I ~ i <br />i <br />f <br />i <br />i j <br />i ~ I <br />i <br />f ~ I <br />Unpaid Balartce <br />of Assessment <br />(e) <br />Place of Fatirtg <br />Rester of Deeds <br />Hal]',. County Total ~ S2r j'39.15 <br />Grand Island, Nebrasta 68801 <br />- ~ <br />This notice was prepared and signed at.__ Grand Island! Nebraska ~____^______~,_ , on this, <br />the__].y,Lh day of March ,19 80 <br />i~ y~--.--------- <br />Signature j Titte <br />le D. Metagez~ ~ Revenue Officer <br />(Hgtta: Cerfillcarp of o/mar auMUrizad 4y raw tp take acknowiedpmenta it not eaxenrial W the valyday of Nollam of <br />FaWral lent Liart G.C.M. 24418, 184P t, C.B. 125.1 <br />Part 1 - To be kept by recording of@ce _ Furm 868 (Rev. s~7s) <br />T,J <br />1..... <br />