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ADAMS COUNTY NE
INST. N0. ~ ~~ 8 Q ~ 4 0
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REGISTER OF DEEDS
RESERVED FOR REGISTER OF DEEDS RECORDING SPACE
ADAMS COUNTY NE
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®~ _~?LcA.Sc CO NO7 WRITE' IN Th115 SPACE
This Notice of State Tax Lien is 3..tau~d oy the ~lebraska Dapartm~ant of I
12s~venue far tanp~lid tax::s pursuarr±to the revenue taws of tt'rE'state Gf j
fJet~raska. iJntit;e is Faereby Given tFsat taxes including penaities grid 1
interest, which are shown beiavrr, are due from the taxpayer speciiiesi
i~eia~v and remain unpaid after denaand. These taxes constitute a Tian
in tFie county i~~r real grad persoraai property belonging to the taxpayer
ar hereafter acgtairwd. _ ._.__ -
Nebraska Identrfiratior~ Num er Federal Identification Nuerber
7674236 ~~ 47-U$036di3
~']ODGr'GO?
20080640
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~E`E~'~ Nt3T1CE ~~ STATE TA3~ LIEN
Lien Serial Nurnyer-~~ T~~-^ ~slE,i'1tv'ith - Soda! Security Number ~rrorase's 5cciai aecumy numuec
r, ? ,/,, ~ / , v r ~, C"Y;egister of Deeds ~Gount; Clerk 5Q$-85-r ~?~'I
Date of Lren ~ Lien Tyra Gcunty
42/1 a/20Q$ L1Crigirral oCortinLaaon ~Gorre,ied AdarrlS
I ~ BUStNF_S5 NAME AND LOCATION AADRESS _ ~ - TA?;PAYER NArVIE AND MAILING ADDftEBS ~ {
Business Marne Marna
Adam Kohl ill
Street AddreSS ~ iStreet cr Gither Uleiling Address
142$ West 2nd .;'
City ~[att, Zip ;ride iC:ity atu~G L~~~~uo
~ i-Iactinnc Ne. 8$9t~1
Categr,ry Tax Period mate of Amoarnt of i'ax ~ Pena+ty Interest AttdlUons ~. Balance of j
Number Assessment Assessment Jve j
U1 ~ufu~r~uvr~ 12/C1lzaU7 4,76~3.2U i,sza.c~s 3oa.g7 6,894.25
os/sar~na7 __
`21 U4101/2t3t77 12I01/20U7 348.30 55.66 14.56 x918.52
09130/%QU7 ~ 1 _,
^-'-- TOTAL $ 7,312.77
r _.
i'hereby certify that the Nahraslce i)epartment ref Revenue has ccmpiied with the revenue Iaws of the State of Nebraska in t ~ determination of the
arnqunt sl^cwn fo tra dus; and the taxpayer has rafted to pay the amount rSue after demand. if this Notice of State Tax Lien is an extension of an
e:ffeci!ve Jien, it sensxrt'~ e~vntir.ua `Ire pr of the s'ate's irteres'. in tre afierrted proaerty et iha taxpayer.
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~,.~ :,- ~ ,__~ ,.~..~ i"~ever~se Agent ~2 : +s r1~~~ 3Q8 3556075
$~~n ~ Pry er~:rs Si na ~ Title '- Date Telephone Number
here ~. /~ Swniar Revsnue Agent ~ '~ ~~
uthorize rgn t re TIt{e pat "
4/.54-ia'4 Re.: 2-2G 72 Supersedes ;-434-to74 Rte. 1 `(1995
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