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04/06/2012 FR= 15:22 FAX 402 471 4429 UCC SECRETARY OF STATE -�-�� 8a11 <br />a <br />�� ► <br />2 012 U �'7 �� �� <br />�J002/003 <br />MCCRBE SHqUNELL <br />FLled: �4/06/2012 10:24 RM <br />3V�rloransico Os�partrioprata� <br />���I�E NOTICE OF STATE TAX LIEN <br />� . w ., v w . , . , . � � , � . , , . �, . . � , o � , • <br />PLEASE DO NOT WRITE IM THIS SPACE <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 hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county fo� real and personal property belonging to the taxpayer <br />or hereafter acauired. <br />8721440 <br />QX Register ot Deeds �County <br />03/24/2012 ( �X Original �Continuation <br />BUSINESS I+IAME AND LOCATION ADDRESS <br />39-1909078 <br />XXX-XX-9286 <br />�corrected I Hal) <br />TAXPAYER NAME AND MAIIING ADDRESS <br />SHAUNELI MCCABE <br />or Other Mailing Address <br />3335 WOODRIVER RD STE #4 <br />Category Tax Period Date of <br />Numi� Assessment <br />21 01/01/2011 11/28/2011 <br />03/31/2011 <br />Amount of Tax <br />K 11 11 <br />GRAND ISLAND NE <br />Penalty Interest Additions <br />105.00 I 13.51 <br />68801 <br />ealance of <br />418.51 <br />TOTAL I $ 418.57 <br />amount shown to be <br />effediva Gen, it serv <br />sign e Prep i <br />here e �/� <br />�Ra uepa�unen� or rcevenue nas compliea wrtn the revenue laws of the State of Nebraska in the determination of the <br />the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Uen is an eMension of an <br />nue the prio of e state's interest fn the affected property of the taxpayer. <br />' -�'� � Revenue Agent y y' 6? ��/� 402 471-6067 <br />�ture Title Dat Telephone Number <br />Senior Revenue A�ent �/_ $'�/� <br />�ture Title Date <br />A118A-1974 Rev. 2-20D2 Supersadas 4-094-7974 Rev.10-1995 <br />