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Rj Natice of State Tax Lien nebraska department attend irutruaions on reverse silo of revenue LFen Sarlal Number Lien Typa Date Spclal Security Number ~~ ~Dri9inal . ~ (3D47~45 01081776 p Renewal ! 8/28/80 i 506-50-2905 Nebraska 1.0. No. County L n filetl Witn Spouse's Soclal Security Regis}^r of Deeoz Number 210046D Hall ^ cppna perk BUSINESS NAME AND LOCATION ADDRESS 1 TAXPAYER NAME ANO MAILING ADDRESS Business NameName Country Squire & Cottage Cafe ' Larry (?vane Hnhhc Street Atltlress i5[reaY o! Otner Malling Atltlress Clty State Zip Cooe City State Zip Code Grand Island, Ne. 68801 Grand Island, Ne. 68801 Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that taxes (including penalties, interest and addiHonsj have been assessed and am due from the above taxpayer and remain unpaid after demand. These taxes • constitute a lien upon properly belonging to the taxpayer, or hereafter acquired by the [axpaycr, and located in the above county. Liens for sales and use taxes only attach to the real property belonging to the taxpayer, or hereafter acqu~ml by the taxpayer, and located in the above county. Tax Date of 1 i Belenw of Category I Tax Period Amount of Tax ~ PenalTy ~ Inters,[ Adtlitiom _,-__ __ i Aaseument I i Ass~ment Due TOTAL ~ S 9$0 3g I herepY cartlty }flat the Nebraska Oepdrtmant of Revenue Y. rnpheC w of Ins State of N l ebraska ~n :ne eater. nditpn of t:fe dmpont sho wn io be Cue, anC t^ payer F, faileC to pdy th -f due attor C s as e • NctYta c' State T Llen ~ n x:lnsion CI an e .a.a. int•_r_3t i...._ a ?eCte•? C.c._r.: _t thn ta-syayar- tisx±~e (ien i. serves ._ continue t a C..ority u9 ?he e7A~~ ~ ~ e l t~E'.yenUe Agent Si [$; r`1(7 ~ ~~ lpa ~r- ~ - _a - ~_I:i~- ~ ?ate ir il ~ ~,_p Special Agent ~/~r\.) 8/28/80 ~- Au~tl Ig ~•-p.~- --H Tltle ~ Oat. ~? FOR COUNTY OFFICIAL'S USE NEBRASKA DEPARTMENT OF REVENUE -- White and Canary Copies TAXPAYER - Puck Copy COUNTY OFFICE -- Gaaenrod Gopv i }