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O1/13/2012 FRx 15:10 FAx 402 471 4429 UCC SECRETARY OF STATE -�-�� Ball <br />�� <br />/ <br />20�.2UO3`78 <br />DRRLIMG PiiTRICA A <br />Filed; 01/13/2012 08:49 FlM <br />Interest I Addltions <br />� <br />Nebraska Dspar-tment af <br />��'��'��� NOTICE OF STATE TAX L1EN <br />wvirw.rev.snue:ne,gcv <br />This Notice of State Tax Lien ls issued by the Nebraska Depa�tment of <br />Revenue for unpaid taues pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes inciuding penalties and <br />interest, which are shown below, are due from the taxpayer speclfled <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for �eal and personal property belonging to the taxpayer <br />or hereafter acquired. <br />40812898 <br />11267871 <br />�Register oF De�s �Counry Clerkl XXX XX-7117 <br />01/11/2072 �original �Continuabon �Corrected HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />PATRICA A DARLING <br />2842 DIERS AVE APT 5 <br />GRAND ISLAIVD NE 68803 <br />Category Tax Period Date of <br />Number Assessmer <br />22 2008 05/24/2010 <br />Amount of Tax Penalty <br />1,476.01 122.05 <br />679.99 <br />�002/005 <br />2,278.05 <br />TOTAL �$ 2,2�s.o5 <br />i nereoy c�oy u�at uie rveorasaa uepartment or ttevenue nas compiieu wrcn tne revenue iaws or tne Srate ot Nenrasxa in me aerermmauon ar uie <br />amount shown to be due, and the taxpayer has faiied to pay the art�unt due after demar�d. If this NoGce of State Tax Lien is an extensian of an <br />effective lien, it se, res ro conlinue the prioriry oF the state s inter�t in the affe�ted propwiy of fhe taxpayer. <br />, Revenue Agent � // / (402)471-5789 <br />sign Preparer' ignature itle Date elephoneNumber <br />here ► �' Revenue Supervisor /, //, / � <br />Signature Title �e <br />4-49I-1974 Rev. 2-2002 Superaedes 4484-1974 Rev.1a1985 <br />\ <br />ti <br />Bafance of <br />Assessment Due <br />