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Q1/09/2012 MON 15:26 FAX 402 471 4429 UCC SECRETARY OF STATE ��� �all <br />� <br />� <br />�0�.2002 <br />�'.IYSbrr�k� �eptal�rl�P.�7 br <br />�003/003 <br />John p Gale - UCC SCON <br />9932681652-6 P9s: 1 <br />DAHMS KRTHY <br />Filed: �1/09/2012 10:24 AP1 <br />ong;n�t ucc -q�a22����5�� <br />on���A1 C�,�� 02oo2oy5�r� <br />�E"�'E�I� NOTICE OF STATE TAX L.fEN <br />www. • �vo n�+o. r. e. v�a v <br />PLEASE DO WOT WRITE IN THIS SPACE <br />This Notice of State Taac Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Natice is hereby given that taxes including penalties and <br />interest, which are �hown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property ioelonging to the taupayer <br />or hereafter acquired. <br />8290199 <br />2-04818 Ox Register of Deeds [] County <br />Lien Type <br />03/16/2002 �Originat QContinuatlon �Corrected Hall � <br />BUSINESS NAME AND L.00ATION ADDRESS TAXPAYER NAME AND MAILING ADORESS <br />� <br />Kathy Dahms <br />t or Other Mailing Address <br />20 St James Place <br />State <br />Category Tax Period Dflte of <br />Number Assessment <br />01 02/01/2000 p311$/2002 <br />OS/31/2000 <br />2 ,� 04I01 /2000 03/18/2002 <br />06/30/2000 � <br />xx-xx-5096 <br />Grand Island NE 68803 <br />Amount of Tax Penaity fnte�est Additions Balance of <br />Assassment Due <br />4,191.82 616.20 737.62 5,545.64 <br />385.05 77.01 56.49 518.55 <br />TOTAL �$ 6,064.19 <br />t hereby cert y that the Nebraska Depaitment of Revenue has complied with me revenue iaws or me ��a�e or rveorasKa �a md ae«rm���au��� �� �,o <br />amount shown to be du�, and th� taxpayer has failed to pay the amount due after demand, lf this Notice of Stata Tax Lien Is an e�dension ot an <br />effactive lien, it serv� to co�tlnue the priority of the state's i�erast in the affected properiy of the taxpayer. <br />e Jim Leuck Revenue Supervisor 01/Q2/2Q12 402 595 <br />sign Preparers Signature �tle Date Telephone Number <br />here e � Revenue Su rvisor 01/02/2012 <br />Autho ' ed Signature Title Date <br />� 411941874 Rev. 2-200Y St+persedes 4494-1974 Rev.10-1&95 <br />l <br />� <br />