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<br /> i PLEASE DO NOT WR1TE IN TF11S SPACE , � .,�,
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<br /> .� INDIVIDtiAL INCOME TAX • ` ` .f.�.. '".` =
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<br /> ,. SOG SEC. NO. 4�9T9235 •. .. . � ° .,�.=-
<br /> NEBR. II9ENT. N0. �gQD3426 � �` ���—".
<br /> SPOUSE SaC. SEC. N0. � ��
<br /> :.�� TAXABI.E YEAR 1992 . �����.-
<br /> �IEN NOo "�:� :,�.:
<br /> ' 963�800a8 AIDA ROElt3IGUEZ ' - --� r.:-,;..;
<br /> Dd1?ETGF MOTICE 12%3/96 4� N MHITE _ ..,..����;� ;
<br /> DATE �F ASSESS�lENT 10/29/9b GRAND ISLlIPt%� N� 6�8d3 � ' '�•�
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<br /> :-%:��� 7HIS NOTICE OF STATE 7AX LIEN IS ISSUED BY THE NEBRASKA DEPARTMENT OF
<br /> REVENUE FOR ZNDIVIDUAL INC��IE 7�l( PURSUANT TO TNE REVENUE LAMS OF THE � '����" °
<br /> . STATE DF NPBRASKA. NBTICE IS N�£�EBY GIVEN YHAT INDIVIDUAL INCOP9g - - ,.�,r._> �`::,�� `
<br /> vAXES INClUDING PENA!'�IES QND �i��ERESTs MHICM ARE SHOMN BELOMI ARE DUE
<br /> FROM THE TAXPAYER SPECIFIED ABO�E AND R�t�lAIN UNPAID AFTEFi DEMAND. �� ��=-
<br /> � TM�SE TAXES CONSTITUtE A LIEN IN TNE C��:t�TY FOR PROPERTY BEL�HGING TO � ` ' � -
<br /> �,.- %.�
<br /> � � YH� TAXPAY�t� 0� FOEREA�YER ACqUYREDo � � ���R� " � "
<br /> -�R�i"`r�er.:.'.tii-.
<br /> AMOUNT OF TAX . o . . . . . . . . . . . . . . . e 497.00 _ ��;,
<br /> �� PENA�TY • a • � � • � • � w • • • � • • • � • • � 12��25 ��;�;�,,;,�__:,s
<br /> INTEREST IC��IPUTED TO 12/13/96) . . . . . . . . . 146.95 "
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<br /> ;�: TOTAL A�l0UA1T OUE • • • • � • • • • • • • • • • • T68�Z0 '` �--;.-�:�.. -
<br /> � ` I H�REBY CERTIF�f TMAT TG�� NEBd3ASi(A DEPARTMENT OF REVENUE fiAS tOMPLIED ' �-�
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<br /> . 6i�TH THE REVEN6I� LAMS OF THE SQQ61fE OF NEBRASKA IH T�4E DETERMINAYION OF :�. ��_�_:
<br /> � 'GHE AMDUNT SHOMP� TO BE DUE� AiiG� 48iE TAXPAYE(i HAS FAILED TO PAY THE ,�,;;s..��:�� ---
<br /> AMOUNT DUE AFTEEt DEa1A�1Do IP tt�Y+ NDTIiCE CF STA'f@ TAX LIEN IS AN �?�:_�`��'���-
<br /> . ,�,r:.;�
<br /> � EXTEt�SEQJ� Of AN EFFECyIVE LIEN IY SEftHE� �0 CONTI�dUE TlfE PREORI'�Y 0� � .;,.:,,�;,,�y� ,
<br />�'`' : THE STA:��S INTEREST IN T�IE AFFECTED PR�i�LR'�Y OF Yt�� TAXPAYEA• . � '%t���
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<br /> � ORIZ SIGNATURE ITI.E ' DATE � - �
<br /> `� NEBRASftA DEPARTMENT OF REVENUE—WhRe nnd Canary Coptas TAXPAYER—Pink Copy COUNTY—Goldenrod Cflpy . � _ �
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