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neb,aslta <br />meaIt <br />TOTAL <br />of revenur <br />Lien Seriar Number- Lien Type <br />X) Original <br />D Renews <br />Nebras"'I D. No. <br />County <br />4789199 <br />Hall <br />BUSINESS NAME , <br />Business Name <br />Llep is an extension of an e n it serves to continue the priority <br />City <br />Gran <br />Tax <br />Catepry <br />NumMt <br />01 <br />21 <br />I <br />Notice of State Tax Lien <br />*Read instructions on reverse tide <br />t Social Security Number <br />31 -86 <br />Filed with spouse's social Security <br />Register of Deetl Number <br />County Clerk <br />PION ADDRESS TAXPAYEI <br />Name <br />Street or Otner Malting A d <br />86-- 103054 <br />NAME AND MAILING AD.DREI <br />J. LVMYa b .r r.r —r. State <br />State Zip COde City <br />d Island, NE_ — 68801 Grand Island NE 68801 <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 />NEBRASKA DEPARTMENT OF REVENUE — white and Goldenrod Copies TAXPAYER — Pink Copy <br />COUNTY OFFICE — Canary COPY <br />4- 494-14 Rev. 7.81 <br />Suparsatles 4- 494.74 Rev.5 -80 <br />u <br />t <br />TOTAL <br />! 989.52 <br />i hereby certify that the Nebraska Department of Revenue has cornplled with the revenue <br />laws of the State of Nebraska in the deter- <br />demand. If this Notice of 5U[e Tax <br />~ <br />:gttnation of the amount shown to <br />be due, and the taxpayer has failed tO pay the amount dug after <br />of the state's interest in the affected Property of the taxpayer. <br />Llep is an extension of an e n it serves to continue the priority <br />S fg <br />Revenue Agent <br />L/, 9- <br />jeffelve <br />Title <br />Date <br />Special Agent <br />Title <br />Date <br />_ <br />Authorizetl SIg un <br />_ <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE — white and Goldenrod Copies TAXPAYER — Pink Copy <br />COUNTY OFFICE — Canary COPY <br />4- 494-14 Rev. 7.81 <br />Suparsatles 4- 494.74 Rev.5 -80 <br />u <br />t <br />