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<br /> � � Notice of State T�x Lien � � -- _
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<br /> PLEASE DO NQT WHIYH IN TNIS SPACE
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<br /> � INDIVIOUAL INCOME TAX �. r •
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<br /> ._.�. S�C� SEt. N0. 50T999631 :��'' {
<br /> � NEBR. IOENT• N�e 32916126 ���• i ; =
<br /> SPOUSE S�C. SEC. N�. 5O63a88a4 �"� � �' ��
<br /> ���� ?AXABLE YEAR 3992 =
<br /> LIEN MG. 963�700Z2 MICHELLE R S RAFAEL O�UTISTA _
<br /> CDlINTY HALL �,1 �:
<br /> OATE OF NOTICE 11/22/9b 30T S OIIK i� ..
<br /> DATE OF ASSESSMENT �i g��6 6RAN� ISLAND N� b6801 "
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<br /> � 'LHIS NOTICE �F STATE TAX I.I�PI IS ISSUED BY THE NE�RASKA DEPARTMENT OF =-
<br /> � IiEYENUE FOR IMDIYIDUAL ZNCOME TAX PURSUANT T� THE 6tE11ENUE LAMS Op TNE :w_
<br /> � STATE Af NEBRASKA. N�TICE IS HEItEBY 6IVEM THAT IPIDIYIIDUAL INCOME � = _
<br /> � TAXES INCI.UDI1l6 PENALTIES AND INT�R�ST� MHICH AI�E SHONN B�L O M A t t E D U E 'ffi°`'°"
<br /> fRQM THE TAXPAYEIi SP�CIFIED AB�YE ANO RENAIN UNPAID ItFTER DEMAhD. .
<br /> � THESE ?AxES CONST3TUTE A LIEN IN THE COUNTy FOR PROPERTY BELON�IN� TO
<br /> THE ?A�tPA�ER OR HEREAF4ER ACqUIRED.
<br /> , � AlIOi�lfY CF 71U� • • • • • • • • • • • • • • • • • • 436.00 :-- --__-.. --
<br />_ �, PEN�L'� w • • • • • • • • • • r • • � • • � � • • �1�8� �� •�� ,
<br /> INTERE5T �COMPl1TE0 TO il/22/96) . • • • • • • • • 126.b5
<br />-- . TATAL RM�UNT IIUE . . . . . . . . . . . . . . . . 584.45 =-__-
<br /> I HEREBY CER?IFY THAT THE NEBItASKA DEPAftT09ENT OF REYEt�iUE HAS COlIPLIED �-- � � -__`
<br /> , . �.��'�S MI�N TiIE REY�NUE O.AMS �F THE STAT.r'e OF NEBRASKA IN THE DE1fERMINATIGN OF `'``
<br /> - '�:� THE APICUPIT SH�MM T� BE D4DE• Akn THE TAl(PAYER HAS FIlYLED YO PAY THE „ ��r, . �'��-�-�t�r=:
<br /> � ' AMOUMT DUE AFTER DEMAkD. IF THIS N�TICE OF STATE T/1X LIEN IS AN -��{3:�, •;r;: �� �
<br /> EXTENSI�N �F AM EFFECTIYE LIEN IY SERYES �� CONTYPIUE THE P�RIORITY GF , '-°:�•:��"` .
<br /> 7HE STwTE�S INTERES7 IN THE wF�ECTED PR�PERTII OF 'PHE T1IXPAY��t. , ��=•'���.:��'4��~�~,
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<br /> � EP R�S SI6NATURE TIT ^ AATE/TELEPHGNE
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<br />_� _,.___� � / AU4NCRIZED GNA'�11�E T LE DATE .
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<br />- / NEBRASitA DEPARTMENT OF REVENUE—White and Canary Copies TAXPAYER—Pink Capy COUNTY�—Goldenrod Copy .,
<br /> .� / IMntW x+�h coy tnx n recyr! pipe� 7.14SiY ROV.1483 Super�Ml3 7.14b7C R!v 6•91 �^�—,
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