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<br /> . INDIYIDUA��I�ICGME TAX :
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<br /> � SOt. SEC. ND. 2Z6023063 � �
<br /> � NEBRs tOENg• NE9. 3i652T95
<br /> ,. 5Pl3USE 50C. SEC• k0. 4�0022246 �°���
<br /> 7A34ABI•E YEAti 3991 ---
<br />� � ll�i� �IO. 960050Q37 DONALD E 8 THERESA L I�OML�IR�D JR � :-�
<br />` ��: COU�fYY �/8j� � . `= =--
<br /> DATE OF N04ItE G1/�56`7b 312 Ct�Q�K�R 8A1G a80 �' --
<br /> . DAT� OF ASSfiSSMEt�T /%��¢�s AVGtA $A ���12 r �
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<br /> . THI� P��"o.$C� f�1F STATE aAX LIEN IS IS�t�ED .b�`.�f6�� N��RASKA DEPA�tT�+1EN3���F •-=-
<br /> . RE�1�ldL'�':��k�, :�NDIYxDUAL I�t6GPlE TAX PURBtdAf.�`�' 'TO $IiE itEYENUE LAiiS OF �� Y �
<br /> S'flty.�"� Ol� FlEBRASKA. .: l�QYIC� IS HERE@1P .�6I'��tsi THA� IHDIYYDdIA� INCOME � �==
<br /> �' . �'��i:� IKCIUDI�if. P�t��.YIES AND INTEf►��1'i � MHICM ARE SHOi�N BELOM �� 1�1�� �-
<br /> �' P�4tl.� TH� TAXPAYER SPE�IFIED /i80VE ��113 REMIIIN UNPATO A�TER AENNND• ��
<br /> } , . TH�SE YA9�ES CONSTI'iUTE A LEEN IPl TH� COUN'1'Y.PGR PRDPER7Y B��A�iGING T0 � ----
<br /> 4HE TAXPAYEQt OR l4EREAFTER AC�iUYREII. � �:.
<br /> �s, ' QGiC'�1lJT QF TAX • w • • • • � •,w • • • • • • � • w �$�QO �'
<br /> . � P6NA��Y � • • • • � • • • • • +p a • � � • • � � • 3t2•95 ;.:�.. —
<br /> INTEREST �COMPUtEO TO 03/+D3/9�r}� • • . • . . �� . • 85.T2 . . s�°�
<br /> . � 'iOTAL A!lOUNT DU£ • � • • • • � .� • a • �. � • � �. 35T.6? ,i;,,: . ,: °
<br /> � .I HEREBY CERT�'rY THAT THE NEBRASiC� OEPARfi�fiE�i� GF RL"-V�NUE HA5 eQ!lPL;Ei� �
<br /> � i1ItH 7NE �EVENUE I.AkS i7F TNE STATE �'� PIE8RA5KA IN THE DETERMYI�ATIG�� ,�F
<br /> �`` 1H�.,.AMQUNT SHONN TO.DE BU�� AN3? T�tE� �'AXPAYEt� HAS FAI��D TD Pi,Y tHE `�; �'
<br /> ��,s . All�1+NT 0ld6 AFF�R D�I�ANA: IF THIS NOTICE OF STl�TE TA� LfEN IS AN -�-:;��� �`'�1
<br /> } � ExT�NSY0Ir1 GF AN @��ECT3VE LI��1 IT SERitES TO lANTINUE TNE P�t�:���IYY 0� �--""�'
<br /> THE. 5YAY��S INTEREST YN TH� APFECTED wROPEQt Y Of THE TIIXPAI7{�3s:o �'=
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<br /> � . / NEBRASK/10EPARTMENTOFRE4�lVUE—WhfteandCenaryG�,t� TAX2AYER—PinkQopy CAU:JR'��ioWenro�flt�y �:—_-
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