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02/28/2012 TUE 14:37 FAX 402 471 4429 UCC SBCRETARY OF STATE ��� Hall <br />I�003/004 <br />� � \ <br />a�"75�r�k.4��,�t e� <br />����� <br />�„�.�.����..�...�. <br />�ie Jahn N Gale - UCC 5TL <br />�2-7 P9S: 1 <br />P9ARLIN <br />28/2012 11:47 HM <br />2012015G7 <br />NOTICE OF STATE TAX LIEN <br />This Notice of State Tax Lten 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 hereby giv�n that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specifled <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the couety for real and personal properly belonging to the taxpayer <br />or hereafter acauired. <br />10657290 <br />� 6 �Reg3sterofDeeds �County <br />lien Type <br />02/16/2012 QX Original �Continuation <br />BUSINESS NAME AND LOCATION ADDRESS <br />Category � Tax Period � Date of <br />01 06/30/2010 08/10/2010 <br />01 07/01 /2010 03/07/2011 <br />01%31/2011 <br />01 03/01 /2011 03/29I2091 <br />D3/31 /2011 <br />01 I Q4/30/2011 I 06/06/2011 <br />Amount of Tax <br />0.00 <br />4,671.15 <br />275.73 <br />161.07 <br />77-0666698 <br />XXX-XX-8878 <br />�coRected I Hall <br />TAXPAYER NAME AND MAILING ADDRESS <br />Marlin Schroeder <br />t or Other Mailing Address <br />204 1 st S� <br />stacs <br />Shelton Ne. <br />Penalty Irrterest Additions <br />0.00 1.48 <br />432.70 292.52 <br />0.00 11.22 <br />25.00 5.89 <br />20.00 <br />20.00 <br />211.96 <br />TOTAL �$ 5,916.76 <br />F <br />_ I <br />� nerepy cert►ry [na[ me rveorasKa uEpartment or rcevenue nas compnea u�ntn tne revenue iaws or me s�aie or rveorasKa �n u,e ae�ermmaaon or me � <br />amount shown to be due, and the texpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien � an extension of an I <br />effective lien, it serv conanue the priority e state's interest in the affected property of the taxpay r. ;' <br />e � Revenue Agent a o � 402 471-6067 . <br />sign Prep rers Signature TiUe D Telephone Number � <br />here � h Senior Revenue Agent _?��_ � L : <br />A thorized Signature TiUe Date � <br />4-094-1974 RBV. 2 2�2 Supersedes 4-084-1974 Rev. 70-7995 <br />� � <br />68876 <br />Balance of <br />Assessment Due <br />1.48 <br />5,396.37 <br />306.95 <br />