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~_~ Forte ~~ ~ /~ /gyp j a Department of the Treasury -Internal Revenue Servic$ I ..~{ } ~' ~ ~ t~~fry {Rev baptemper ly7197~ ~t~tECE ~1 ~r4d~ra! 'fax l.~n U~ader I~term~a9 ~~~rer~c~e i.af /~f(~ Q~t$triCt ___ _ _ - _ ~ Sena! t+iumbef ~ ~ !___I.-. For Lononef ils® av Necprs~rg t>ptg@ ~. ~ 53262 i-- %~-airi 4 ~ ~ I As provided by sections 8321, 8322, and 8323 of the Internal Revenue Cede, ~ Mice is rven that takes iirrcludi ~ g ng interest and p8nalties! have been assessed , against #te fa~?!~i[4q-nati~d t~epgye<. ~essR. fe! y~yment of this 'isbilirif is&s j bean mate, fsut it remains unpaid. Therefore. there is a Lien in flavor of the United States on at! property and rights to property belonging fo this taxpayer for the 1 atruxrnt of the taxe3, and additional pet ties, i:tterr:st, and costs that may awe. ± °~ ~ ~axpayar Staril.ey Si.nwsl j dud .caiPis9i uiSCt7.•.':ii ~ i 1211 W 4t;, Street ~ Grarst3 Islandr Nebraska 588G1 ~~'pJJ q = ~i .~StKi ~ Y~ t~ Ll t ~ ~ ~ t ~ ~~~IW ~#ol - 0? ~ 12-32-317 ~ U3-Ib-~1 !t`$+ff` 47-~59413t~ rV 3,b4~.72 r[acs w rnrng Register o: Z3s x,413,-3L"j iri tiai'... F ;~ -s t,~t -f vT'etsrf Isldr>cl* Nsbrsskd C'>t3St}1 js{k,,..t2 This nuticexr~ premed arxi s~ned at Grdrnd_Isldrxt~__!iebrdska __.__ _ --..---------, .on this. ttre __. 2~th day Df .arc h _ . t 9 81 - S~ _~____ ___ ~__-,.~____ H.G. l~ictii3.Liasns .Ir. ~ Reva-iue 4Fficer (llaik ~-srt=r+c:ae cn ra~!saa a,:xMUrrsA L; ~s +a ra.e ~_~newra~-~.=~ s rbt aaxe=st~: ~ tf2s .afK6X~ at fftilz~ a0-. i<NAw3~ '.as i;6n C. C.iY INa r9, l~'a i.CB t75.j Pltrt t - To b0 t~~gli t3y 9 b5~' Form i'>~ (Rev, ~T8}