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No#ice of ~#ate'° Tax Lien <br />nebraska <br />ttepxtment •Read inrtructions on reverse side <br />Lten Serial Number Lien Yyp@ <br />` Date"„ <br />'~ So<iai'Security Number <br />~ <br /> <br /> <br />12/01 /314 <br />~ Original <br />^ ReneWai <br /> <br />12-16-81 <br />( ~~ <br />'J c <br />~ (L161.T ~.! <br />_ <br />Nebraska I.O. No. County Lien Filed With Spouse's Social Security <br /> ~i Register of Deetls Number <br />3875148 Hall Q cJpnty clerk <br />_ BUSINESS NAME AND LOCATION ADDRESS <br />Business Name Name <br />r k Mr. <br />Street Address Street or <br />371 West Stoney Park Road 3311 <br />City State Zip Code City <br />Mailing Atld!ess <br />Zlp Cotle <br />68801 <br />This Notice of State Tax Lien is issued by the Nebraska Uepaztment of Revenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are <br />shown below, aze due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a Lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Category <br />Tax Period Data of ~- <br />Assessment Amount of Tax ~ Penalty Intarart <br />Additions Balanee of <br />Assessment Due <br />Number t -~ <br /> 12-1-80 thru <br />O1 1 12-31-80 12-09-81i 628.27 19,43 i 77,11 724.81 <br /> 1-1-81 thru <br />O1 ~1-31-81 12-09-81 7?1.08 24.47 ~ 98.60 904.15 <br /> ;2-1-81 thru <br />O1 1 2-28-81 12-09-81- 622.83 19.26 i 62,35 704.44 <br /> <br />O1 3-1-81 thru <br />3-31-81 ~ ' <br />12-09-81~ 761,55 23.55 57.47 <br />~ <br />852.57 <br /> 4-1-81 thru ~ <br />------r-- ------;------- <br />I <br />O1 4-30-81 ! 19.?7_ ~ 49.02 <br />12-09-8 639.06 i I ~ 7n7.95 <br /> <br />O1 5-1-81 thru <br />5-31-81 ~ ~_ <br />! <br />12-D9-8~ 570.48 17.54 ~ 37.20 <br />~ <br />~ 625.32 <br /> 6-1-81 thru <br />Ol 6-30-$1 12-09-8! 480.76 ~ 14,31 i 25.63 ~_ I 521.20 <br /> TOTAL ~ s 5,040,34 <br /> I Hereby Certlly that the Nebraskd Depar[ment of Revan ue has cool pita4 with the revenue IaWS Vf the JWlO ,~t Nebl esxd In the ueltlr~ <br /> m lneLipn pf the dmbUnt SttOWn tU ba Uua, dnd the tdxpeye( hat tdil@d [n Vay the din OUnt UUe ltler Uemand. it tnls Npllce lit Sla(e Tax <br /> Lien IS an @xtenslen of an at1eC11W lion rt Ssrves t0 tontin ue the Vrlurtty Vt the stal@'s ~nleraft In tn@ arteCt@d NrJ <br />~ p@fty JL the taxpay@r. <br />~1~n ~ Agent <br />Revenue <br />1 <br />~ ~~+'~ ~~ <br />~ Preperer's tur! - <br />- ~ <br />- - - . <br />P-1tt• Date <br />~~~,, . Special Agent ~_________ - __ <br /> Autnor.a~d eture - - _ True _ <br />-"gate <br /> I~O~ GtlUN~Y Of FiCYAL'3 US€ <br />_- _~ . .. ..-_ __ _. - _ ~_-_-._..__~_....e..~._...._....._ _„ ...-_ _ _. - -___..._. ._.__.. ___. <br />NEtt~A§IfA DEPAgTMENt OF HEVENU€ -~ Whlteend utxdenrod 4van+ <br />~AXPAyE=ti i'+nk Copy L:OUN (Y (3f=k{f~E --- (.angry f:c>Ety <br />a-aJe-fa Net. ? al <br />superwoe+a-avo~ta Rer, ,-au <br /> <br /> <br />