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<br /> TA131IVIDUAL INCO� 'P�lt �� >`�'__- _.
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<br /> IF YOU INQUaRE A��f�4 V�UR _. _' - a .:,.—
<br />' A�CQUNTt Ia��R TO YY�iESE NUHB�RS: :� �•` �: �j,: �a
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<br /> S�C. SEC. NO. ���r=�- ,...._
<br /> . IDENT• H0• 36TTO136 =;.��� .�;'�,`.;# ..T,
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<br /> 1995 SHANE GENDER :`-r ��....� .
<br /> �AlU19LE YEAR ..'"'�.•.�
<br /> '' 218 MAW43T 5Y PO BN( �T1� �`.''����:,.�
<br /> LIEN N0. 9b2430069 ,'`�' �`
<br /> LYEN RELEA�E N0. 970t�2,A5��64 AVOCA IA 51�21 ��"
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<br /> DATE �� Id0'6ICE 01128/9� ,�''����, 1�- t"S
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<br /> � PURSUANT TO YHE ttEVENUE LAYS OF THE S7ATE aF NEBRASKAs t�T=C� IS ----- =� � _
<br /> ��.•, ME(e�f'cBY 6IVEN BY �ME NFBRASKA DfP/IRTNENT 0� REYENUE T�T THE .-�__,,
<br /> � T�pYE�DR INDIYID AL IB�AME TIIXES�ISOTE�l4INATED.E ABOYE NAMED -��-
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<br /> � I HEREBY �CERTIFY THAT 7HE NEBisASKA DERARTMEN? Gf REYENUE �'-�S CQJ�LYE� `<_� �6
<br /> � YITH ?HE REVENU� LdMS Or THE STATE OF tiEBRASKA IQ� TyE OE?ERMINATIOAI OF ��.,p�.��-�",
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<br /> ;�j 1t�8RASKA DEAARTMENT dF R='VENUE—VMite an RI D . :;, --
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