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02/08/2012 w$D 15:17 FAx 402 471 4429 UCC SEC�:TARY OF STATE -�-�-� Hall <br />� 1 ` <br />_ <br />L <br />2012�0 �.� 2'� <br />����� <br />�1' S4r'Y1Y{'i.+i����fiiY <br />�003/004 <br />- - �ann q �1¢ - pC6 57L <br />i84532-5 Pes : i <br />GERSON <br />: 02/08/2012 10:56 qf�1 <br />NCITICE OF STATE TAX LIEN <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is her�by given that taxes including penalties and <br />interest, which are shown below� are due from the taxpayer specified <br />below and remaln unpaid after demand. These Na�ces constitute a lien <br />in the county for �eal and personal property belonging to the taxpayer <br />or hereafter acauired. <br />10684867 <br />Category <br />Number <br />01 <br />01 <br />01 <br />01 <br />01 <br />� O L a., QX Register of Deeds �County <br />Lien Type <br />02/02/2012 QX Original �Continuation �Corrected Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />. <br />Gerson W. Camey <br />t or Other Mailing Address <br />1523 Sylvan St. Apt #1 <br />State <br />Grand Island Ne. <br />Penaity Interest Addtttons <br />Tax Pe�tod I Date of <br />04/30/2010 10/02/2011 <br />05/01 /2 010 10/0212 011 <br />05/31/2010 <br />06/01 /2010 � 0/02/2011 <br />06/30/2010 <br />07/31 /2010 10/02/2011 <br />08/01/2010 10/02/2011 <br />09/30/2010 <br />Amount of Tax <br />300.00 <br />300.00 <br />300.00 <br />300.00 <br />600.00 <br />XXX-XX-7088 <br />60.00 25.40 <br />60.00 24.12 <br />60.00 22.89 <br />60.00 21.62 <br />120.00 39.45 <br />68801 <br />Batance of <br />:essmant Due <br />385.40 <br />384.12 <br />382.89 <br />381.62 <br />759.45 <br />TOTAL � $ 2,293.48 <br />i nereoy cemry ma� me rveorasKa uepartmem or Kevenue nas Compliea wttn tne revenue iaws ot tne State oT NenrasKa m cne ae[erminauon ot tne <br />emount shown to be due, and the taxpayer has failed to pay the amount due after demand. IF this NoGce of 5tate Tax Lien is an axtension of an <br />effective lien, it serve ntinue the priorit he stete's interest in the afPected property of the taxpayer <br />e • Revenue Agent ,?/,�y�Z.,. 402 471-6067 <br />sign reparers Signa re Title � � Telephone Number <br />here e Senior Revenue Agent a-�• /� <br />uthorized Signatu Tide Date <br />4�494-1974 Rev. 2 2002 Supetsedea 4�9q-7974 Rev.10-1995 <br />r <br />