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<br />�-` . t� � INST $ 93-103827 G� �� ��� !x --
<br />"i i . � PLEASE�O HQT WRRE tIA IfQS SPACE �C, ' • . ,.� '�1,'s-
<br /> �;-__ . .-."c 7b1s Natice of State Ta�I1ea is tssue8 hy the NebrasI�I?epartment oP -- -���..-K�r.'=
<br /> ;,: _ Reveane for oapaid taxes putsaant to We revenue laws of the s�eff - �'
<br /> '•� • Nebraslm. Natt� is[te�sby given that�Incindtug pen�Lties� - .. � '�
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<br /> .�� ,'�. tnbe�whicb are show�n�[ow,oze dQe 6om the taxpayer sp�fBed •�. •v��=A.��,
<br /> <.:`" : beds�iv�nd remalm aapaid after demand. These tages constItate a li�In ';�,`.i-:,_ t,�'�::i:r.
<br /> _ ,_:. . �z��,for i+eal and p�sonal propertq 6e�ongtng to We taspayer or '�� •=:.',�.
<br /> : � heteaRer acqat�d. -_"'?�_
<br /> N86rastra IQ '�ttm�Niunber llen Rted WM 8odai 8enuiry a Fed�ai I.D.N�anba Spa�se's8adai Sec�utlyNumb¢r
<br /> � ��. ' 28750365 �a�scerwo�easpco�nyaerx 263-35-3276 505-94-3359 },;;�"`,
<br /> - ' ,. ' cs,s�rnmm� auenrypa vateorua► co�any ``' � 'f::,
<br /> � � g30220d13 D°i�' �C°""�10" Q°oir�d 05—OS-93 HALL ?�"� _
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<br /> � • . •J BUSiNESS MA6lE AND LOCATfOH ADDAESS TAXPAYER NAPdE AND MAILING ADDAES3 ' :' ��
<br /> f, . Bustrtesa lYeme Name . ' ''1�=
<br /> ,,.'
<br /> -� . . ;�� GEORGE E & SHELLEY LOOSCSEN =-
<br /> _.. StreetAd�r85s strcetarOdterMai9ngAGQrmas '; r.
<br /> � . � � 9930 PARPIDISE DR � �
<br /> � ' �1' czry bZus uoCvoe cnY s� 7,�COOe ; ,
<br /> ' � ';�'� �; SCOTTSDALE A 852 0 ' '�r
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<br /> �'�� . I�eaory TmcPeited �� AmountofT� P�natty t� Ad�tiona Ass�io�ntDu� . "• , • ~�.-
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<br /> � TOTAL $ , �
<br /> � . IrterebyoertltythattheNebraskeOepartrnm»ofReverwehavoomptieGxAl�BigrevemielawsW�eSfateolNeDraskalnttieAetermir�llon ' ' ' •
<br /> ' offiaemounlshownto�edue.arb0�e�aymhastafte0wpayf�aamountauearteraeman0.BitusNONCeofStateTaxUenbanm4�slono} � .
<br /> -. .- aneBeow ten.ftcerva9t000rttlw pAOr.ryofthestate'amterest theattecte0prapenyotttfe�ayrec . �
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<br /> ' ���e a� e e ' /-�1-9d' i�081.�8S-Go7S . .,
<br /> .. ' � � TetepNate No.
<br /> . �
<br /> A�hnr�a] e 1
<br /> �� " NEBRASKA DEPAATA�ENT OF REVENUE-Whtte and Ciotden ad Copies TAXPAYER-Pintt Copy COUtYf'Y OFFICH-Canary Ca�y
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