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<br /> �i" PLfASE IX�MOT WRITE IN TFNS SPACE
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<br /> = . � '�'���a�' Ti�RMIMATI�N OF STATE TAX dIEN
<br />_. . � INDI1�xDUAL INCOME TAX
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<br />'�"'�*��'.� SFaUSE SL�C« SEC. N0. � CREG A SCHURER
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<br /> ===.W'��'� O.IEN l�i0• 9�23xCO28 110 MEST TOfYRD S7 �� 60X 183
<br />����� LI�N RELERS� t�. 9633tG�89 �LDA NE b8810
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<br />`°""�'"� DATE OF NOTICE 1102bl96
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<br />�'°"� YNSTItUMENT NQ. •�������•
<br /> _ �--�_� PURSL+ANT Tp Ti1�C REY�MtlE �Ai1S C� THE STA�� OLF N�1��i�►�K4� !�!��'ICE 3S -
<br /> --.--__ HERE�Y CYVEN BY 'iHE NEBItASKA DEPARTMENT GF ti�Y�t�i�� �HwT '�HE
<br /> STATE TAX LIEN MH�CN HAS SEEN DUi.Y FILED A�AINST THE �18aVE NAMED
<br /> —=--.�-:z„� TAXPA1fER FOR INDIOIIDUAL IIiCOME ZAxES IS TERMIkA7ED.
<br /> � I HEREBY CERTIFY THAT THE MEBRAS�l1 D�PAR'�MEMT OF REYEMUE i1AS COMPLYED
<br /> -=���— MITH THE REIfENUE LQYS OF TiiE S1A�E G� MEBRASKA IM THE DETEiilIINA��ON OF
<br /> THIS TERMIWITI�M.
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<br /> -_ _. , AUTIiORIZEa SI6NATURE TITlE DA'�E �
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<br /> - �-_ , NEBRASKA DEPARTMEIVT OF HEVENUE—Whits and Canary Coples TAXPAYER--Plnk Caov COUNTY—C3ddenrod C�Y
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