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{ .__ <br />{ - - _ - ~ . - r - - - - - - -. ,.,. - <br />1 E ° tN.ST~tElL €1O~ L <br /> 'fy3r <br />~' PURPEf3E 4F FO%RIM.;Tl?is fora[ is to be ttsed by the ebraska - t'n~-' <br />t Depanment of Reventtr for the°purpose vf. notifying the appraptiatr- - - - - . <br />_ <br />county authoritks that a Notice of State Twat Lien .h being filed _ _ <br />- - <br />against the taxpayerindicated-oa this form. - <br />' <br />. <br />_ <br />. <br />. <br />- - The tax category number codes attd ~ Nebraska tax pr~anisthey <br />~' <br /> <br />represent are listed below. ~ ~ -- - - - - <br />i <br />,_ ,:, ........... . ..'::Sales Tax :.. ; ;_ <br />- - 02 ............... ..........Retailers Use Tax - <br />I, <br />.. - 04 .....:... ...............Consumers Llse.Tax - <br />- - <br />. ~- - <br />10 ... . ........................Pori-mutuel _. <br />- 46 :.....:.: ............... _ ... Estate Tax <br />.`~ 21 ....:.......:.......Income Tax Withholding ~ - <br />~ <br />- ~ - - <br />: <br />. _ - - -_ - ............. {ndividua! Inrame Tag <br />: <br />..; ~ <br />. <br />.. <br />. .. . ......... ... . .. .....Fiduciary {nc@rtte Twat :~ <br />. 23 <br />- <br />. ~ <br />~ <br />' '- ,:.~.. -. 24 ...........Corporate Income and FraneJ»se Tax -~, -- _ _ <br />- _ _ <br />- - . <br />- <br />.... :- - <br />'-`-- ~ .. .Mechanical Amusement bevice Tax -:• <br />44-......'... - <br />36 .....Documentary Stamp.Taz - - _..- _- -..: `"~ - - <br />- 47 ......:.....................Cigarette Tax _. - _ _... <br />- .. .. ~ 45' .: ........................Severance Tax - - - <br />71 .............Interstate Motor Carriers Fuel Tax - <br />. - 81 ...........MotorVehideFuelslmportingDesler. - _.. ~'~,- --~ <br />85 ..........................Aircraft Fuels ~ ~ - ', _- <br />_ ~.. 91 .:.......................:.Special Fuels ~ - ,-.. <br />~ ~_ r_t <br />Q @ ~ ~ m <br />`:` . t _ 7 <br />c '. rn O N <br />~~ ~m Q a <br />.~ N <br />;, ` `- ~' ~ <br />O va <br />O <br />_~ ~ <br />L L.. ~ <br /> <br />