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O1/26/2012 THU 14:54 FAX 402 471 4429 UCC SECRETARY OF STATE ��� Hall <br />� <br />PLEASE RETURN T0: <br />NEBRASKA DEPTOF REVENUE <br />1313 FARNAM-ON THE-MALL <br />OMAHA NE 68102-1871 <br />20120069'7 <br />�J003/003 <br />�aie - ucc sr� <br />P9s: 1 <br />:61 FlM <br />� <br />Nebraska Deperiment of <br />F�FVENUE NOTICE OF STATE TAX LIEN <br />www.revenue.ne.gov <br />This Notice of State Taac Lien is issued by the Nebraska Oepartment of <br />Revenue fo� unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby gNen that taxes including penalties and <br />[nterest, which are shown below� are due from the taxpayer specifled <br />below and remain unpaid after d�mand. These taxes constltute a lien <br />in the county for real and personal proper[y belonging to the taxpayer <br />or hereafter acauired. <br />97229326 <br />11268199 <br />n <br />�R�Ister of Deeds �County Clerkl XXX XX-8288 <br />01/18/2012 �Original �Cantinuatlon �Corrected HALL <br />BUSINESS NARAE AND LOCATION ADDRE3S TAXPAYER NAME AND MAILING ADDtiESS <br />JASON PARMENTER <br />2720 N WEBB RD � <br />GRAND ISIAND NE 68803 <br />Category <br />Number <br />22 <br />22 <br />22 <br />Tax PeNod � Date o( <br />2004 � 07/15/2009 <br />2006 � 07l15/2009 <br />200T � 07/15/2008 <br />Amount of Tax Penaity <br />302.89 95.25 <br />1,007.00 251.75 <br />1,190.00 I 354.50 <br />Interest Additlons <br />141.15 <br />291.70 <br />249.25 <br />Balance oI <br />sessment Due <br />538.29 <br />1,550.45 <br />1,793.75 <br />TOTAL � $ 3,883.49 <br />i �ic�wy wuir uiai uio roeu�as�ca uepaMIB�1I O� It2Y811U8 I183 �II1�tN� W11h Vle feV@IIU@ lBWS OT fhC S[H1@ Of N2bI8Sk8 U11hC (IBtP.R111118dOfl Of � <br />amount shown to be due, and the ta�ayer has fa�ed to pay the amount due after demand. If this Nn6ce of State Tau Lien is an e�dension of an <br />e(fective lien, it serves to cont�ue the p rity of the 's inte�t in the aff�ted propeAy of the taxpayer. <br />� Revenue Agent —�� - f Z (308)632-9203 <br />sign Prepar s g ure Tttie Date Telepho Num er <br />here ► � Revenue Supervisor G�I / J7� <br />Autiaoru� d Sig re Tdle D <br />4494•19?4 Rev 2-2002 Supersedee 4-491-1974 Rev.1a199b � <br />•�� <br />.` <br />� <br />