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~_,-.__ <br />~O$ICp® O~ ~~i~!! T8X ~.{~11 <br />tittbrsska <br />moment <br />ipiid 111atfYOttOOi On faaHlrM tidi <br />Lien SiriYl iVUmber Llen Yypi Diti Soclai Set:ur y Number " <br /> Orl9inal - <br /> <br />'~ <br />^ Raoewal <br />- - <br />5 ~ Q (~ a} <br />8 <br /> <br />Nabtaaka I.D. Np. <br />County <br />LiM FFieO Wlth <br />Re9lster of Deed <br />SppuseY SDalii'SeCUrity <br />umber 1-~ OQU53.~ <br /> County Clerk <br />a. - i.. - g43St :g~NA~ Srt3 LDLATt~ A6'wt3@35 TA%PAYER fdARRE.AND MAlliNls.4Ql~t#E^~S <br />auHnass Name Name - - <br />F Sfreat_Rddrass StlMt pr Other cNaxin9 Addres3 <br />[- City S4Me Zip Cptlo City State Z <br />_ grand Island a 688Q1 <br />E' Pursuant to the revenue laws of the State of NebrHdca, twtiae 6 herebv n that fixes (includin <br />e 1P"e 8 prnaltin, interest <br />_ and additions) have been assessed and are due firnn the -..'~e.~ taz;lau sad remain unpaid after demand.'ih~ tgxes <br />rnastidtte a lien upon property beMvtghtg to the taxpayer. or hereafter acquired by tip taxpayer. and located in the <br />above county. s.ietts far sales and use taxes Drily aifas't to the ~! gr..pcrty belatiEging to the taxpayer, a heresfler <br />acquired by the taxpayer, and located in the abovd ccntnty. <br />T.e <br />NC~Y <br />Tttx Patdd <br />AaiatartaM <br />Amoum of Tax PanNty I <br />tntnai4 <br />Addiiiors <br />AY~nint Dw <br /> 1-i-SO thru <br /> 4-1-i30 thru i <br /> 7-I-80 thru <br /> <br />- - <br /> <br />- - ~ <br />i i <br /> ~ <br /> 1 ~ <br /> I ~ <br /> <br /> ToraE ~ 5 440.60 <br /> i hereby Certify that the Nebraska Department of Revenue not coin piYed wlin the revenue laws of the State Of Nebraska in the tleter- <br /> m{nation Of the dmpUni ShOyln t0 b¢ dUe. and [he taxpayer hi3 iai.atl t0 pay the amount dpe after demand. i f YFU3 NO[ice Of $tiie Tax <br /> LIM # M extinaidn of an effective n It Serves t0 continue the priority Of t he state's interesS in the atfa<ted property OI the taxpayer. <br />- e <br />~~ <br />~~ ~ <br />Revenue Agent <br />,~i- ~ d"/ <br />~a . <br />Prepar !a Sign Title Dat <br />~ <br />^ <br />s <br />S'ecial Agent <br />,2- - ~~ <br /> nurnati~ Sienat Title Date <br />NEBRASKA DEPARTMENT OF REVENUE - YYhite and Canary Copies TAXPAYER -Pink Copy <br />COUNTY OFFICE -Goldenrod Copy <br />4>9a-7a Rev. 12-79 <br />Si~ersedex 4-x9474 Rav. 5-79 <br />U <br />' ` ~ _ <br />{~ <br />