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~. <br />~~~C~ ~f'~#BIt~' ~8X L1~ <br />- .~` - ~ •Rsad instruetidna pat reyaaae side <br /> <br />Llaes SMaI Numtda <br /> <br />1 11 143 1_i+n TYP+ <br />Original <br />O Reneval Date- - <br />~ <br />1i-18-81 Soclat $+eurity Number <br />- <br />507 66 7107 - - _ _ _ <br /> <br />7a~~a1 ~^ ~/y eyf <br />~ <br />~~ <br />~ <br />Nebraska I.D. No. County Liars Piled NHM <br />Ra9lster of peed Spouse's Social Security <br />Number " <br />• V <br />v y - <br />~+ <br />'A <br />_- 3810798 Ha11 County clerk ~~ <br />~._ <br />Business Name <br />CS <br />Street Pitldress <br />305 G <br />Sity <br />font <br />or <br />State Zip Coda City Stale <br />raj r;ter_ NE 6882b Alda, ____ NE <br />This Notice of State Tax Lien is issued by the Nebraska Dep~dnent of Revenue for L1Itp81d faze putswnC2o the <br />revenue laws of the sts:e of Nebraska. Notice is hereby given thrd taxes including penaltiea and interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. Thee taxes constitute <br />a lien in the county far real and personal property belonging to the taxpayer a hereafter acquired. <br />lax <br />t:adaprY <br />Ntarebsr <br />Tax Period OaN of <br />A>iassrnent <br />Amount of Tax <br />PenahY <br />Intanet <br />Additions 8aiatta~ of - <br />Asrwlnaltt-Ow <br /> <br />21 0-i-80 thru <br />12-31-80 <br />10-22-81 <br />53.80 <br />3.69 <br />4.62 <br />62.11' <br /> <br />2i 1-1-8i thru <br />3-3i-8i ~ <br />6-16-e1 <br />12.05 <br />.60 <br />.61 <br />13.26 <br /> <br /> <br /> <br /> <br /> <br />TOTAL ~ $ 75,37 <br />i hereby Certily trial ihi Nebraska iNWrTntent of Revenue has eumpilab wfth the revenue iaWS b} the $taU Of IWOraska in the Oetar- <br />_ mmattpn 01 the d 5nOWn tb be OYi. dnd the taxpayer haf failed to pay Ihi amount tlue aitif OemanO. I1 tnii NO[1Ca bf $taif ~Ta% <br />Lien It an akt of an iitic[Iva ~n it serves to ~Mi~lnw the priority of fns state's intarl3t in the of}acted prep+atY pr'the taxpayer. <br />' ~ ~ ,~ Revenue ~gnt ~_ 11-1.8-81 <br />~~ ~ r - - - Tiu. - - Data <br />-~---~_ Speelai Agent _ 11-18-81 <br />- _ - _ - R ; - ~ _. _.~ _ .,~ Tats ....___.__ .., ~a4e ~~...n....~. <br />- ~~.r __~ .._..-~ <br />-- __..- - - - - -. - -- - - -_ - FtSw DCiUNT V O~FtCiAL'S-USA <br />t. <br />- <br />NFs~IASKA [>ffPARTMENT OF REVENUE - Wh{ttand fioldanrod CL•pias TA%PAYER -Pink Copy <br /> <br />NAME ANO LO(:A7 <br /> <br />COUNTY OFFICE - CaaarY Cppy <br />4494.74 R+v, 7.91 <br />Sup+r3+o+s 4.494-74 Rev. 5•ao_- <br />J <br /> <br />