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raska <br />�me�tt <br />Notice of State Tax Lien <br />e p..d instructions on re_ side <br />Lien Serial Number <br />Lien Type <br />Date —T <br />Social Security Number <br />Penalty <br />Interest <br />j] Original <br />Balance of <br />Assessment Out <br />21 <br />07 -01 -85 thru <br />-30 -85 <br />6/031239 <br />E) Renewal <br />3 -26 -86 <br />508 -40 -0237 <br />$�— 1(1150 <br />Nebraska I.D. NO. <br />County <br />Lien Filed With <br />Spouse's Social Security <br />3998126 <br />Hall <br />t]E Register of Deed <br />Number <br />_ <br />376.86 <br />® County Clark <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING AOOR£SS <br />Business Name - <br />Name —!--- <br />Goodrich Dairy Mobile Store <br />Darrel E. Schwaderer <br />Street Address <br />Street or Other Mailing Address <br />1528 North Lafayette <br />J P.O. Box 39 <br />City State <br />Zip Coda <br />lCity State Zip Code <br />Grand Island, NE <br />68801 <br />!Wood River, NE 68883 <br />This Notice of State Tax Lien is issued by the Nebraska Department of Revenue for unpaid taxes pursuant to the <br />revenue laws of the state of Nebraska. Notice is hereby given that taxes including penalties and interest, which are <br />shown below, are due from the taxpayer specified above and remain unpaid after demand. These taxes constitute <br />a lien in the county for real and personal property belonging to the taxpayer or hereafter acquired. <br />Tax <br />Catapory <br />Number <br />Tax Period <br />Date of <br />Assessment <br />' Amount of Tax <br />Penalty <br />Interest <br />Additions <br />Balance of <br />Assessment Out <br />21 <br />07 -01 -85 thru <br />-30 -85 <br />10 -31 -85 <br />342.46 <br />17.12 <br />19,18 <br />378.76 <br />1 <br />10 -01 -85 thru <br />12-31-85 <br />2 -18 -85 <br />_ <br />351.97 <br />17.60 + <br />7 -29 <br />_ <br />376.86 <br />1 <br />r <br />i <br />TOTAL <br />$ 755.62 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the deter- <br />' mination of t mount Sh0 to be due, and the taxpayer has failed to pay the amount due after demand. if this Notice of State Tax <br />` Lien is an Sion of an elf ctive lien 1 serves to co tinue the priority of the state's interest in the affected property of the taxpayer. <br />sign - �= Revenue Agent _ 3 -27 -86 <br />here Os ture Title Date <br />Special Anent 3 -27 -86 <br />Authorized signs tire Title Date <br />. r FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE – White and Goldenrod Copies TAXPAYER – Pink Copy <br />10 <br />COUNTY OFFICE – Canary Copy <br />4-494 -74 Rev. 7.81 <br />Supersedes 4- 444.74 Rev. 5.80 <br />U <br />I <br />L J <br />