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Perm ,. , ~ , ° ''. ~ Departmen4 of I,iB Treaaury -Internal Revenue 5ervlca <br />(Rev. 9aalambar,9T9) ~- ~1~t~$~'Of derai Tax Li$ot Under Internal Ravenna Lags <br />District _ _ °' - _ ~ Serial Number ~ _ MFOr opnonat uae br Reaardtltq o)bca <br />Oraat,a _ . _.4~s::,•° ~ 38335 <br />_.___~_~ L ______ <br />As provided by sections 821, 8822, and 88 of the Internal Revenue Code, <br />notice is giver, that taxes Eincluding interest and penaihes) have teen assessed ~ 8 ~ +ar.~ ~ ~ ~ ~ 4 <br />against the following-named taxpayer. i7emartd fw payment of this )lability has <br />bean made, but it remains unpaid. Therefore. ttlKe is a lien in favor of the United <br />States on ail property and rights to property belonging to this taxpayer far the <br />amount of these taxes, and additional penalties, interest, and c~2s that may <br />accrue. <br />Name of Taxpayer <br />John D, 8+ Georgia I, Lacey <br />Shelton, Nebraska 68876 <br />tip of Tax ~ Tax P Ended ' il~te of id~fyNeg Number ~ • . <br />ta) tb} tc) tdl tal <br />1040 - 30 7612 { 06-16_80 IMF 507-34-5271 3327:53 <br />09-08-80 72.46 <br />10-20-80 33.66: <br />11-10-8U 39.05 <br />11-24-SU 33.35 <br />12-08-80 i ~ 34,00 <br />PtaevofFiling Register of Deeds ~ <br />Count of Hall <br />Grarrdylsland, Nebraska 6881)t T~1 `= 3506.SI <br />,~,--°-----------,--'-:__-.,-. Grand Island, Nebraska __..:_ <br />the -.,8th day of Ap r x i -_ , t g ~ ~ _______.-- <br />Signature -_-~- Title <br />.....= <br />Lyle 0, Metz a Revenue Officer <br />tND4= i:erri/rt;ate of ofteew aurl9nrtte0 by rp take scin„rvleeements .s not aseenria! to the ri,Mity of Atorke o! <br />fWera: lea L.en t3. C. ef. .611®, *DSP+, C.9. t75 ) <br />Part t - To be by reeordiny-office'' term 68$ (rRev. &78y <br /> <br /> <br /> <br /> <br />